Modality treatment in adult stage I-II Hodgkin's disease with large mediastinal masses: study of 30 cases and review of the literature.
From January 1980 to December 1989, 30 untreated patients with supradiaphragmatic Hodgkin's disease (HD) stage IA to IIBE, presenting a mediastinal mass with mediastinal to thoracic ratio (MTR) > or = 0.33, were treated by combined modality therapy. None had staging laparotomy and the range of MTR was 0.33 to 0.60 (mean 0.43). In the entire group. MOPP chemotherapy (2 or 3 cycles) was followed by mantle irradiation of 40-45 Grays over 26 to 30 days and paraaortic-splenic pedicle irradiation of 30 Grays over 19 days. Complete remission (CR) was achieved in 26 of 30 patients (87%). The remaining 4 patients who failed to respond to initial chemotherapy received salvage chemotherapy and/or autologous bone marrow transplantation (ABMT). With a median follow-up time of 72 months (range 11 to 131 months), overall survival and disease free survival (DFS) were 86% and 78% respectively at 10 years. Five relapses were observed after 10 to 63 months of CR. Among five patients (3 relapsing and 2 failing to respond) who received intensive chemotherapy and/or ABMT, complete remission was obtained in 4 (80%). Univariate analysis of different risk factors such as age, systemic symptoms, E-lesions, histological subtype, sex, MTR and response to initial chemotherapy indicated that early response to chemotherapy was the only significant factor influencing overall survival (p < 0.001). Intensive chemotherapy with ABMT is suggested for patients failing to respond to initial chemotherapy or relapsing after combined modality treatment.
Grigoraki
V
V
Département d'Hématologie, Groupe Hospitalier Pitié-Salpétrière, Paris, France.
Lilienthal
F
F
Touboul
E
E
Gabarre
J
J
Binet
J L
JL
Merle-Béral
H
H
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D011241:Prednisone