Stage IA-IIB Hodgkin's disease: staging and treatment of patients with large mediastinal adenopathy.
Ninety-two patients with clinically staged (CS) IA-IIB Hodgkin's disease (HD) with large mediastinal adenopathy (LMA) underwent three different staging and treatment approaches between April 1969 and December 1984. These approaches included: (1) staging laparotomy followed by radiation therapy (RT) alone; (2) staging laparotomy followed by combined RT and chemotherapy (CMT); or (3) clinical staging followed by CMT. Patients treated with CMT were more likely to have "B" symptoms, extension into extranodal sites, or stage III disease. Patients treated with RT alone had a significantly higher risk of relapse as compared to patients receiving CMT. No overall survival differences were seen between the three groups of patients. For patients treated with CMT without RT to the spleen or abdominal nodes, the risk of relapse in the abdomen was low (4%). These data suggest that for those CS I-II HD patients with LMA who are treated with CMT, the role for staging laparotomy and abdominal irradiation is limited. RT alone remains an option for some patients with LMA, but careful assessment of the anatomic extent of thoracic disease as well as staging laparotomy is essential if such treatment is recommended.
Leopold
K A
KA
Joint Center for Radiation Therapy, Boston, MA 02115.
Canellos
G P
GP
Rosenthal
D
D
Shulman
L N
LN
Weinstein
H
H
Mauch
P
P
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D007813:Laparotomy; D008198:Lymph Nodes / Q000473:pathology; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies