title: Infradiaphragmatic Hodgkin's disease: the Swedish National Care Programme experience. The Swedish Lymphoma Study Group.
abstract: A Swedish national care programme has provided guidelines for staging, treatment and follow-up of all patients with Hodgkin's disease (HD) since 1985. Between January 1985 and December 1992, 920 patients were reported and followed prospectively. Of a total of 533 patients with stage I and II disease, 484 presented with supradiaphragmatic HD and 49 (9%) with infradiaphragmatic HD. The median follow-up time was 4.3 yr (3.3-10 yr). Significant differences in average age (45 +/- 21 yr and 55 +/- 19 yr), male:female ratio (1.1:1 and 2.8:1) and B-symptoms (25% and 47%) were observed in patients with supra- and infradiaphragmatic HD, respectively. Forty-six patients with infradiaphragmatic HD were treated with a curative intention and 40 (87%) achieved a complete response. Eleven (28%) of the 40 patients have recurred and 8 patients have died of HD. Complete response rates and recurrence frequencies did not differ from those observed in patients with supradiaphragmatic HD. Mortality was, however, significantly higher (p = 0.001) in the infradiaphragmatic group; this was due mainly to poorer effects of salvage treatment in a elderly population. In this population-based study, patients with peripheral disease in stage IA respond well to inverted Y irradiation alone, whereas it appears to be important to give stage II patients chemotherapy or a combined modality treatment in order to avoid unacceptably high recurrence rates.
authors.affiliation: Department of Oncology, University of Uppsala, University Hospital, Sweden. Karl_Mikael.Kalkner@onkologi.uu.se
authors.forename: K M
authors.initials: KM
authors.lastname: Kälkner
authors.forename: G
authors.initials: G
authors.lastname: Enblad
authors.forename: A
authors.initials: A
authors.lastname: Gustavsson
authors.forename: H
authors.initials: H
authors.lastname: Starkhammar
authors.forename: I
authors.initials: I
authors.lastname: Branehög
authors.forename: P
authors.initials: P
authors.lastname: Lenner
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006689:Hodgkin Disease / Q000145:classification / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012737:Sex Factors; D016019:Survival Analysis; D013548:Sweden; D016896:Treatment Outcome