Laparotomy-stagedIA versusIIA Hodgkin's disease. A comparative study with evaluation of prognostic factors for stageIIA disease

Abstract

Ninety-one laparotomy-staged (LAP) IA and IIA Hodgkin's disease (HD) patients were analyzed to evaluate the prognostic significance of stage, mediastinal status, extranodal disease and histology. Forty IA patients were treated with radiotherapy (XRT) only; of 51 IIA patients, 44 received XRT only and 7 had additional chemotherapy. Disease-free survival (DFS) at 5 and 10 years was 81% and 70%, respectively, with overall survival (S) of 93% and 86%, respectively. Disease-free survival for IA patients (93% at 5 and 10 years) was significantly superior to IIA (73% at 5 years, 52% at 10 years). Survival differences were not statistically significant. For IIA patients receiving XRT only, large mediastinal disease was an adverse factor for DFS. Small mediastinal disease in IIA was significantly better than no mediastinal disease. For the whole group of LAP IA and IIA treated by XRT only, three prognostic groups were identified: (1) Stage IA and Stage IIA with mediastinal disease, but less than 7.5 cm in width was highly favorable with less than 10% relapse; (2) Stage IIA nonmediastinal had an intermediate prognosis with relapse in about 33%; (3) Stage IIA large mediastinal (greater than or equal to 7.5 cm) had an unfavorable DFS with relapse in about 55%. The third group contained a highly unfavorable subset with mediastinal masses greater than 10 cm, all of whom relapsed. Salvage therapy was successful in 60% of relapsing patients. In the context of relatively effective salvage therapy, the role of adjuvant chemotherapy in adverse prognostic groups is discussed and it is concluded that the only clearly justifiable use for adjuvant chemotherapy is in patients with massive (greater than 10 cm) mediastinal adenopathy.

Significance of E-lesions in Hodgkin lymphoma and the creation of a new consensus definition: a report from SEARCH

“…We observed that 26 articles used the Ann Arbor criteria for staging classification, 12 , 15 , 18 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 45 , 46 , 47 , 51 , 53 , 54 , 55 , 56 9 articles used the Cotswolds revision of the Ann Arbor staging classification, 30 , 33 , 42 , 43 , 44 , 48 , 49 , 50 and 1 study used the Lugano criteria. 52 Fourteen studies provided some description of E-lesion location.…”

“…In the 36 articles analyzed, 12 640 patients (aged 2-88 years) with stage I-III HL were included. Five articles included solely pediatric patients (aged 0-18 years), 15 , 30 , 31 , 32 , 33 19 articles included children and adults, 18 , 22 , 27 , 28 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 7 included only adults, 48 , 49 , 50 , 51 , 52 , 53 , 54 and 5 articles 23 , 25 , 26 , 55 , 56 provided limited information about patient age.…”

“… 52 Fourteen studies provided some description of E-lesion location. 12 , 22 , 23 , 25 , 26 , 28 , 32 , 33 , 34 , 35 , 39 , 45 , 46 , 53 , 56 …”

“…In the 36 articles analyzed, 1330 of the 11 602 unique patients (12.4%) had an E-lesion (results summarized in Table 4 ). Sixteen articles 15 , 22 , 26 , 28 , 30 , 31 , 33 , 38 , 43 , 44 , 46 , 47 , 52 , 53 , 55 , 56 encompassing 3888 patients provided stage-specific E-lesion incidence data. E-lesions were rarely present in stage I disease, affecting 1.1% (4/365) of patients (range, 0%-6%).…”

“…Five articles, 22 , 23 , 39 , 41 , 56 encompassing 869 patients, described nuanced prognostic relationships between study groups. Hodgson et al 39 noted that in patients with stage I-II HL treated with CMT, the site of extranodal extension determined the impact on disease outcomes; patients with chest-wall E-lesions but not lung E-lesions had poorer cause-specific and overall survival compared with those with only nodal disease.…”