The significance of residual mediastinal abnormality on the chest radiograph following treatment for Hodgkin's disease.

Abstract

The chest radiographs (CXRs) of 110 patients with mediastinal Hodgkin's disease (HD) were reviewed to determine the incidence, degree, and significance of mediastinal abnormalities following treatment. Residual mediastinal abnormalities were defined as either minimal or measurable, and occurred in 64% of all patients at the completion of treatment, but were more common in those with bulky mediastinal disease at presentation (40 of 48, 83%). Fifty-one patients with a mediastinal abnormality at the end of treatment had follow-up films available. Partial or complete regression of the abnormality occurred by 1 year in 30 of these patients (59%). Over a median follow-up of 80.5 months, there were more relapses (13 of 70, 19%) in patients with residual abnormalities following treatment than in those where the mediastinum was considered normal (four of 40, 10%). Measurable abnormality was associated with a higher relapse rate (six of 25, 24%) than minimal abnormality (seven of 45, 16%), but none of these differences were statistically significant. the subsequent relapse rate for patients with persisting abnormality at 1 year was 14%, compared with 17% for patients in whom regression had occurred and 14% in whom the mediastinum had always been considered normal. Considering the whole group, the presence of a mediastinal abnormality following treatment did not predict for relapse, but for the 34 patients treated by chemotherapy (CTR) alone, a residual abnormality was associated with a significantly higher relapse rate (P = .029). We conclude that following mediastinal radiotherapy (XRT) administered either alone or combined with CTR, residual mediastinal abnormalities do not indicate the need for further treatment. However, following CTR alone, such abnormalities may signify persisting disease and we recommend that XRT be considered for these patients.

18F-FDG PET for Posttherapy Assessment of Hodgkin's Disease and Aggressive Non-Hodgkin's Lymphoma: A Systematic Review

“…Persi stence of a mass after completion of first-line therapy is a common problem in assessing the response of both Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) (1,2). Based on the likelihood of residual disease, clinicians need to proceed to further therapeutic interventions such as applying radiotherapy to the residual mass or salvage chemotherapy with or without high-dose chemotherapy followed by stem cell transplantation.…”

Primary Resistant Course and Recurrence of the Hodgkin,s Lymphoma. Preventable Losses at “Most Recoverable” Hemoblastosis

“…Как показано при инициальной терапии ЛХ, особенно при массивном поражении на момент начала лечения, у ряда больных сокращения размеров опухолевых оча-гов, достаточного для констатации ремиссии, не про-исходит, однако очаги не содержат жизнеспособной опухоли. Похожие проблемы отмечаются и при оценке эффективности терапии 2-й линии (индукционной терапии) [59,60]. Возможность же морфологического подтверждения ремиссии существует далеко не всегда.…”

Hodgkin's Disease

“…Resections and biopsies of residual expansion revealed no signs of active disease (48). No increased risk for relapse was found in patients with residual mediastinal expansion after combination therapy (42,43). X-ray examination I year after treatment shows that residual expansion continued to shrink without further treatment (42,43,49).…”

“…X-ray examination after treatment shows residual expansion in up to 80%, particularly when involvement was extensive on debut (42,43). This leads to the question of whether active residual disease is present or if the changes involve fibrotic tissue only.…”