title: Hodgkin's disease presenting below the diaphragm. The experience of the Gruppo Italiano Studio Linfomi (GISL).
abstract: OBJECTIVE
  Infradiaphragmatic Hodgkin's disease is rare, making up 5-12% of cases in clinical stages I and II; consequently, several questions concerning prognosis and treatment strategy remain to be answered. The aim of this study was to analyze the clinical and prognostic characteristics and outcome of this condition.
  
  
  METHODS
  A series of 282 patients with CS I-II Hodgkin's disease (HD) was investigated. In 31 patients the disease was confined below the diaphragm (BDHD), and in the remaining above the diaphragm (ADHD). The presenting features and outcomes were compared in the two groups.
  
  
  RESULTS
  The BDHD group was older (p < 0.0002), had a higher frequency of males (p < 0.08) and a different histological subtype group distribution (p < 0.0001). Stage II BDHD patients had a worse overall survival rate (OS) than stage II ADHD patients (68.8% vs 86.6% at 8 years, p < 0.01) if age is not considered; patients with more than 40 years of age, in fact, had the same survival rates as those with ADHD. BDHD patients with intra-abdominal disease alone had worse prognostic factors and OS (p = 0.12) than patients with inguinal-femoral nodes.
  
  
  CONCLUSIONS
  Although BDHD patients present distinct features, they have the same OS and relapse-free survival rate as age-adjusted ADHD patients. According to our experience patients with stage I peripheral BDHD respond well to radiotherapy-based regimens. Those with stage II and or intra-abdominal disease are more challenging; chemotherapy or a combined therapy seem to be more suitable approaches for these patients.
authors.affiliation: Ematologia e Centro Trapianto di Midollo, Università di Palermo, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Iannitto
authors.forename: V
authors.initials: V
authors.lastname: Accurso
authors.forename: M
authors.initials: M
authors.lastname: Federico
authors.forename: D
authors.initials: D
authors.lastname: Vallisa
authors.forename: C
authors.initials: C
authors.lastname: Pieresca
authors.forename: S F
authors.initials: SF
authors.lastname: Gravina
authors.forename: F
authors.initials: F
authors.lastname: Di Costanzo
authors.forename: R
authors.initials: R
authors.lastname: Di Trapani
authors.forename: V
authors.initials: V
authors.lastname: Silingardi
authors.forename: G
authors.initials: G
authors.lastname: Mariani
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000473:pathology; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000473:pathology*; D013160:Splenic Neoplasms / Q000473:pathology*