Mantle Irradiation Alone for Clinical Stage I-II Hodgkin's Disease: Long-Term Follow-Up and Analysis of Prognostic Factors in 261 Patients

Wirth, Andrew; Ma, Chao; Corry, June; Laidlaw, C.; Yuen, Kally; Ryan, Graeme B.; Byram, D; Davis, Sally J.; Kiffer, John D; Quong, George; Liew, Kuen Hoe

doi:10.1200/jco.1999.17.1.230

Cited by 23 publications

(12 citation statements)

References 38 publications

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“…In a previous study of mantle-field RT for patients with clinical Stage I and II Hodgkin lymphoma, we reported that patients diagnosed with LPHL had a 10-year freedom from progression rate of 80% compared with 50% for patients diagnosed with classic Hodgkin lymphoma, a difference that was significant after adjusting for other prognostic factors. 17 Studies of earlystage follicular NHL treated with RT alone have reported durable remission rates of 40 -50%. 27,28 These results suggest that LPHL has a natural history that is distinct from both classic Hodgkin lymphoma and follicular NHL.…”

Section: Discussionmentioning

confidence: 99%

“…17,27 Thus even if the current series included a proportion of patients who currently would be classified with classic Hodgkin lymphoma or follicular NHL, it is unlikely that we overestimated the results of RT for LPHL. Another potential limitation of this study was the difficulty in distinguishing reliably between the progression of LPHL and the development of a new NHL.…”

Section: 11mentioning

confidence: 95%

“…Some patients have been included in previous series. [17][18][19][20] Staging was according to the Ann Arbor system. 21 If involvement of a site was ambiguous, then it was coded as uninvolved, uncertain stage was coded as the lower of two possible stages, and B symptoms were coded as present only if they were unequivocal on chart review.…”

Section: Methodsmentioning

confidence: 99%

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Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Wirth

Yuen

Bartoň

et al. 2005

Cancer

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BACKGROUNDThe curative potential of radiotherapy (RT) alone as initial treatment for patients with Stage I–II lymphocyte‐predominant Hodgkin lymphoma (LPHL) has not been defined well.METHODSTwo hundred two patients who were treated between 1969 and 1995 were evaluated in a retrospective, multicenter study.RESULTSPatient characteristics were as follows: The median age was 31 years, 75% of patients were male, 80% of patients had Ann Arbor Stage I disease, 1% of patients had bulky disease, 3% of patients had B symptoms, 1% of patients had extranodal involvement, and 80% of patients had supradiaphragmatic disease. The RT fields were a full mantle field in 52% of patients, less than a full mantle field in 24% of patients, an inverted‐Y field in 17% of patients, less than an inverted‐Y field in 3% of patients, and total lymph node irradiation in 3% of patients. The median dose was 36 Gray. The median follow‐up was 15 years. The overall survival (OS) rate at 15 years was 83%, and freedom from progression (FFP) was observed in 82% of patients, including 84% of patients with Stage I disease and 73% of patients with Stage II disease. No recurrent LPHL and only 1 patient with non‐Hodgkin lymphoma (NHL) were reported after 15 years. Adverse prognostic factors that were identified on multifactor analysis were as follows: for OS, age 45 years or older (P < 0.0005), the presence of B symptoms (P = 0.002), increasing number of sites (P = 0.015); for FFP, increasing number of sites (P = 0.002). No significant difference was found in FFP in a comparison of patients who received elective mediastinal RT with patients who did not receive mediastinal RT (P = 0.11). Causes of death at 15 years were LPHL in 3% of patients, NHL in 2% of patients, in‐field malignancy in 2% of patients, in‐field cardiac/respiratory in 4% of patients, and other in 6% of patients.CONCLUSIONSThe current data suggested that RT potentially may be curative for patients with Stage I–II LPHL and raise the possibility that limited‐field RT may be used without loss of treatment efficacy. Involved‐field RT warrants further investigation for patients with early‐stage LPHL. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: 11mentioning

confidence: 95%

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Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Wirth

Yuen

Bartoň

et al. 2005

Cancer

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“…Because less than 33% of deaths among patients with Stage I-II LPHD are due to Hodgkin disease, compared with 50% of deaths among patients with CHD, 5 and because LPHD uncommonly involves the paraaortic lymph nodes or the spleen on presentation, 4,9,10 some groups 26,27 have suggested that mantle radiotherapy alone is the preferred treatment for patients with VF or F LPHD. 7,28 For example, Backstrand et al 28 in Boston have suggested that mantle irradiation alone may be preferable from a quality-oflife standpoint and may reduce the risk of solid tumors compared with STNI.…”

Section: Discussionmentioning

confidence: 99%

European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte very favorable and favorable, lymphocyte‐predominant Hodgkin disease

Wilder

Schlembach

Jones

et al. 2002

Cancer

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BACKGROUNDLymphocyte‐predominant Hodgkin disease (LPHD) is rare and has a natural history different from that of classic Hodgkin disease. There is little information in the literature regarding the role of chemotherapy in patients with early‐stage LPHD. The objective of this study was to examine recurrence free survival (RFS), overall survival (OS), and patterns of first recurrence in patients with LPHD who were treated with radiotherapy alone or with chemotherapy followed by radiotherapy.METHODSFrom 1963 to 1996, 48 consecutive patients ages 16–49 years (median, 28 years) with Ann Arbor Stage I (n = 30 patients) or Stage II (n = 18 patients), very favorable (VF; n = 5 patients) or favorable (F; n = 43 patients) LPHD, according to the European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte (EORTC‐GELA) criteria, received radiotherapy alone (n = 37 patients) or received chemotherapy followed by radiotherapy (n = 11 patients). The percentages of patients with VF disease (11% vs. 9% in the radiotherapy group vs. the chemotherapy plus radiotherapy group, respectively) or F disease (89% vs. 91%, respectively) within the two treatment groups were similar (P = 1.00). A median of three cycles of chemotherapy with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or with mitoxantrone, vincristine, vinblastine, and prednisone (NOVP) was given initially to six patients and five patients, respectively. A median total radiotherapy dose of 40 grays (Gy) given in daily fractions of 2.0 Gy was delivered to both treatment groups.RESULTSThe median follow‐up was 9.3 years, and 98% of patients were observed for ≥ 3.0 years. RFS was similar for patients who were treated with radiotherapy alone and patients who were treated with chemotherapy followed by radiotherapy (10‐year survival rates: 77% and 68%, respectively; P = 0.89). The OS rate also was similar for the two groups (10‐year survival rates: 90% and 100%, respectively; P = 0.43). MOPP or NOVP chemotherapy did not reduce the risk of recurrence outside of the radiotherapy fields.CONCLUSIONSMOPP or NOVP chemotherapy did not improve RFS or OS significantly in patients with VF or F LPHD, although the statistical power was limited. Ongoing clinical trials will help to clarify the role of a watch‐and‐wait strategy or systemic therapy, including anthracycline (epirubicin or doxorubicin), bleomycin, and vinblastine‐based chemotherapy or antibody‐based approaches, in the treatment of these patients. Cancer 2002;94:1731–8. © 2002 American Cancer Society.DOI 10.1002/cncr.10404

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“…Radiation therapy is commonly used for treatment of HD 8 but other options include chemotherapy, combined modality treatment and, in selected cases, postoperative observation only. 9 In cases of HD involving the supradiaphragmatic lymph nodes the radiotherapy technique commonly implemented is the mantle technique.…”

Section: Treatment Optionsmentioning

confidence: 99%

Minimising the risk: reducing breast tissue dose in an adolescent female

Thompson¹,

Teo

Ungureanu

et al. 2005

Radiographer

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Breast cancer is amongst the leading radiation‐associated, second malignancies that develop in patients after treatment for Hodgkin's disease. This risk is affected by two main factors: The age of the patient at the time of radiotherapy; and The dose received by the breast tissue The adolescent female thus faces an exceptionally high risk, as breast tissue at this age is undergoing rapid developmental growth and small doses of radiation exposure could be carcinogenic. This case report of a fifteen‐year‐old girl who received radiotherapy for Hodgkin's disease demonstrates how radiation therapists worked together with the radiation oncologists and medical physicists to provide an optimal treatment plan for a high‐risk patient.

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Mantle Irradiation Alone for Clinical Stage I-II Hodgkin's Disease: Long-Term Follow-Up and Analysis of Prognostic Factors in 261 Patients

Abstract: These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.

Cited by 23 publications

References 38 publications

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

European Organization for Research and Treatment of Cancer and Groupe d'Etude des Lymphomes de l'Adulte very favorable and favorable, lymphocyte‐predominant Hodgkin disease

Minimising the risk: reducing breast tissue dose in an adolescent female

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