Treatment Regimen
The mStanford V regimen (Table 2s) consisted of chemotherapy for 12 consecutive weeks followed by involved-field radiation therapy (IFRT). The chemotherapy was: prednisone 40mg/m2 orally divided bid every other day for 10 weeks followed by a 2 week taper, doxorubicin 25 mg/m2 and vinblastine 6 mg/m2 on weeks 1, 3, 5, 7, 9 and 11; cyclophosphamide 600 mg/m2on weeks 1, 5 and 9; vincristine 1.4 mg/m2 (maximum of 2mg) and bleomycin 5 UI/m2 on weeks 2, 4, 6, 8, 10 and 12 and etoposide 60 mg/m2 on days 1 and 2 of weeks 3, 7 and 11. The modification from the original StanfordV regimen7, consisted of the substitution of cyclophosphamide 600 mg/m2/dose, instead of mechlorethamine 6mg/m2/dose. Radiation therapy (cobalt unit or linear accelerator) was administered to all originally involved sites of disease according to their response to chemotherapy at either 2000cGy to the sites that achieved an anatomic complete remission (> 80% reduction of the sum of the perpendicular diameters or return to normal size lymph nodes) or 2500cGy to the sites that did not achieved a complete remission. Chemotherapy was held for 1 week if ANC was less than 1000 and/or platelets less than 100,000 on the weeks that included doxorubicin. All patients received pneumocystis jovenci prophylaxis with trimethoprim/sulfamethoxazole. Some units were able to give filgrastim to patients with prolonged neutropenia and infection at the discretion of the local teating physician and availability of the drug. All members met weekly by video conference through www.cure4Kids.org to discuss problem cases.