Cure of early-stage Hodgkin's disease with subtotal nodal irradiation

Abstract

Ninety‐four consecutive patients with Stage I or II Hodgkin's disease who presented supradiaphragmatically were treated with radiation therapy alone at the Mallinckrodt Institute of Radiology from January 1978 through December 1986. Fifty‐two patients (55%) were staged pathologically, and 42 (45%) were staged clinically. The latter included lymphangiography and/or abdominal computed tomographic scan. Most patients with B symptoms and/or bulky disease were excluded from this series. Seventy‐four patients were treated with subtotal nodal irradiation (mantle and periaortic fields). The spleen was treated if the patient had not undergone splenectomy. Twenty patients received mantle irradiation only. No patient received total nodal irradiation. All patients had an initial complete response. With a minimum follow‐up of 7 months (median, 7.7 years; seven patients died before 3 years of follow‐up, but all other patients had at least 3 years of follow‐up), 81 patients (86%) remained disease‐free. Six of 52 (12%) of the pathologically staged group had a relapse, as did seven of 42 (17%) of the clinically staged group (P = 0.68). Eight of 57 Stage I patients versus five of 37 Stage II patients had a relapse (P > 0.99). Analysis of disease‐free survival by age, histologic findings, sex, and sites of involvement did not predict relapse. The pelvis was the most common site of failure (nine patients, 10%). However, only three patients (3%) failed in the pelvis alone. These results indicate that patients who, after adequate clinical staging with selective use of staging laparotomy, are found to have Stage I and II Hodgkin's disease may be treated with subtotal nodal irradiation with a high rate of cure.

Evolution of Radiation Therapy Within the German Hodgkin Study Group Trials

“…However, other well-recommended study groups could not confirm these excellent results. [7][8][9][10] Because secondary cancers were reported in up to 10% of patients after high-dose extended field (EF)-RT, the GHSG created the HD4 study, which tested in a randomized setting a dose reduction of 10 Gy in the EF (EF-RT 40 Gy vs. EF-RT 30 Gy/ IF-RT 40 Gy) for patients with PS IA, IB, IIA, IIB with no risk factors (large mediastinal mass, extranodal extension, massive spleen involvement, ≥ 3 lymph node areas, high erythrocyte sedimentation rate [ESR]). Staging laparotomy was obligatory in this protocol.…”

Hodgkin's Disease

“…Approximately 15% to 35% relapse (4)(5)(6)(8)(9)(10)(11)(12)(13), in whom salvage chemotherapy or combination therapy yields new remission in most cases (75% to 90%) (9,10,12,14). Approximately 75"h to 90% of patients with localized Hodgkin's disease who receive radiotherapy are alive after 10 to 20 years (4, 1 I , 13,15).…”

“…Less than 10% of those receiving STNI experience relapse below the irradiated field (12,13,20,21) and survival does not appear to be worse in these patients. TNI is, therefore, viewed as an unnecessarily extensive treatment method, although some programs use TNI for localized supradiaphragmatic disease (21 ).…”