A total of 57 patients with Hodgkin's disease limited to above the diaphragm (Stages I and II, A and B) were treated with radiation therapy alone at the University of Florida between 1964 and 1974. Staging laparotomy was done on 24 patients (42%). A total of 16 patients have relapsed, 4 within the treatment fields, 3 marginally, and 9 as extensions. Analysis of dose vs. size showed no in-field failure with disease less than 6 cm in size, with a range of doses. Massive disease continued to recur occasionally, even with higher doses. Most of the massive disease was mediastinal or hilar; the risk of lung or pleural involvement as determined by x-ray and/or biopsy showed a dramatic increase with size of mediastinal/hilar disease. Only 2 (5%) of 43 patients with mediastinal disease less than 6 cm in size had lung or pleural involvement, compared with 10 (71%) of 14 patients with disease greater than 6 cm in size. Both in-field recurrence and generalized relapse were closely related to the number of anatomical sites involved. Treatment programs need to consider tumor size, particularly in the mediastinum, and the number of sites involved.
Thirty patients under 20 years of age with non‐Hodgkin's lymphoma, with nodal and extranodal involvement, were reviewed retrospectively according to Rappaport's classification. All cases had a diffuse histologic pattern. There were 10 patients with lymphoblastic lymphoma (nine with convoluted nuclei and one with non‐convoluted nuclei), 10 with Burkitt's lymphoma, six with undifferentiated lymphoma, and four with histiocytic lymphoma. Histochemistry was done in 28 cases, and electron microscopy in three. Twenty‐four patients were male and six were female; ages at presentation ranged from 3 to 19 years. Nine patients with lymphoblastic lymphoma (with convoluted nuclei) and two with Burkitt's lymphoma had a mediastinal mass at diagnosis. Three patients with Burkitt's lymphoma and one with undifferentiated lymphoma had bone marrow involvement initially. Leukemic transformation occurred in four patients with lymphoblastic lymphoma within a year of diagnosis. Initial treatment included radiotherapy alone in three patients, chemotherapy alone in three patients, and combined radiotherapy and chemotherapy in 24 patients. Thirteen patients have died at 2 to 52 months from diagnosis: five of 10 with lymphoblastic lymphoma, three of 10 with Burkitt's lymphoma, four of six with undifferentiated lymphoma, and one of four with histiocytic lymphoma. Our findings suggest that in this patient population, non‐Hodgkin's lymphoma can be classified using Rappaport's criteria and that malignant lymphomas of the lymphoblastic type and undifferentiated lymphoma seem to have the worst prognosis.
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