Prognostic groups for management of localized Hodgkin's disease.

Abstract

Two hundred fifty-two patients receiving radical irradiation for clinical stages I and II Hodgkin's disease between 1968 to 1977 had an actuarial ten-year survival rate of 78% and a relapse-free rate of 61%. Sixty-seven patients receiving chemotherapy followed by radiation had a 78% survival rate and a 63% relapse-free rate. Independent prognostic factors for survival and relapse were age, stage, and histology. Disease bulk was predictive only of relapse. Neither site of presentation above or below the diaphragm nor presence of mediastinal involvement was predictive for survival or relapse; however, patients with large mediastinal masses (greater than or equal to 10 cm absolute diameter) had a significantly higher intrathoracic failure rate with conventional mantle irradiation. Analysis of failure, according to age, clinical stage, and histologic type, showed three groups of patients defined according to the risk of relapse with radiation therapy: those with isolated upper cervical stage IA disease (group 1, relapse rate 8%), younger patients with localized stages I and II disease of favorable histologic type (group 2, relapse rate 35%), and older patients with extensive or symptomatic stages I and II disease of less favorable histologic type (group 3, relapse rate 70%). Subsequent analysis of radiation treatment volume indicates that the use of upper abdominal irradiation for patients in group No. 2 could yield results equivalent to those achieved with radiation therapy for surgically staged patients.

Early stage Hodgkin’s disease in adults: which is the correct treatment?

“…Large radiation fields are used in extended field radiotherapy ('mantle' or 'inverted Y') but the dose necessary to control disease is relatively low (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45) Gy). "2"3 With appropriate shielding of the lungs and a large portion of the heart the incidence of transient pneumonitis is low and there is no significant cardiac toxicity.…”

Results of a randomized study of early stage Hodgkin's disease using ABVD, EBVD, or MBVD

“…It is now accepted that patients with pathologically documented stages I or I1 can achieve complete remission (CR) over 90-95% [I-31. However, an approximately 2540% relapse rate is reported in some centers as well as by multicenter studies [4][5][6][7][8]. Although most of these patients can achieve a second long remission, approximately 30% of these patients may die of Hodgkin's disease [4,8].…”

How to define intermediate stage in Hodgkin's lymphoma?

“…Actually, the prognosis of localized Hodgkin's lymphoma (HL) patients may be assessed by at least three different scoring systems (1)(2)(3)(4)(5)(6)(7). These systems which are based on several distinct prognostic factors are used for dividing clinical stage (CS) I and II localized HL patients into favourable and intermediate/unfavourable subgroups.…”