The management of stage II supradiaphragmatic Hodgkin's disease at St. Bartholomew's hospital: A retrospective review of 114 previously untreated patients over 14 years

Abstract

Between January, 1968 and July, 1981, 114 consecutive patients with newly diagnosed supradiaphragmatic Stage II Hodgkin's disease were treated at St. Bartholomew's Hospital on the basis of pathologic staging (PS) in 56 (47 IIA, 9 IIB) and clinical staging (CS) in 58 (23 IIA, 35 IIB). Complete remission (CR) was achieved in 104 (91%) patients, of whom 27 have relapsed. Ninety‐three patients remain alive, the cumulative predicted survival at 10 years being 81%, with a minimum follow‐up of 2 years and a maximum of 15 years. Mantle radiotherapy (RT) was prescribed for 76 patients, of whom 67 (88%) entered CR. The duration of CR correlated inversely with the presence of intrathoracic lymphadenopathy. No patient with PS IIA and a normal chest radiograph has yet relapsed, whereas in contrast, a rising probability of relapse is related to increasing volume of intrathoracic lymphadenopathy. Combination chemotherapy (CT) with mustine, vinblastine, procarbazine, and prednisone (MVPP) was prescribed to 38 patients, 27 with “B” symptoms and 11 Stage IIA patients with “unfavorable” features. CR was attained in 32 (84%) patients, of whom 24 subsequently proceeded to mantle irradiation. Only one of these has relapsed, compared to two of eight patients who did not receive adjuvant RT (P = NS). The duration of remission of patients receiving combined modality therapy (CT + RT) or CT alone was significantly longer (P < 0.05) than that of patients receiving RT alone, in spite of the fact that the CT + RT group comprised predominantly patients with unfavorable features.

Tumour burden in early stage Hodgkin's disease: the single most important prognostic factor for outcome after radiotherapy

“…Mediastinal involvement, particularly bulky mediastinal involvement, has in many studies been shown to adversely influence disease free survival after radiotherapy (Nissen & Nordentoft, 1982;Liew et al, 1984;Thar et al, 1979;Leslie et al, 1985;Dorreen et al, 1984;Hoppe et al, 1982;Lee et al, 1980;Schomberg et al, 1984;Mauch et al, 1982). In most earlier studies it has, however, not been taken into account that mediastinal involvement is rare in stage I whereas it is very common in stage II.…”

Second primary malignant neoplasms in patients treated for hodgkin's disease at st bartholomew's hospital

“…Radical treatment with curative intent comprised either combination chemotherapy with mustine, vinblastine, procarbazine and prednisolone (MVPP) (Sutcliffe et al, 1978) or extended field radiotherapy (Timothy et al, 1978;Lister et al, 1983) or both (Dorreen et al, 1984).…”

Hodgkin's disease in adults: the challenge

“…Most investigators consider that this is an unacceptably high relapse rate and that 'more therapy', either in copyright. the form of lung irradiation or chemotherapy is required (Lee et al, 1980;Prosnitz et al, 1980;Mauch et al, 1978;Hoppe et al, 1982;Dorreen et al, 1984).…”