Stage I-III Hodgkin's disease: outcome and pattern of failure following treatment with radiation therapy and chemotherapy in a modern era.
OBJECTIVE
To analyse the long term outcome, pattern of failure and treatment related complications after radiation therapy (RT) with or without chemotherapy for stage I-III Hodgkin's disease (HD).


METHODS
Detailed records from 86 patients with stage I-III HD treated between 1989 and 1998, were retrospectively reviewed. Seventeen patients with favourable stage I-IIA were treated with RT alone, and the remaining 69 patients with combined modality treatment (CMT). Patients treated with RT received extended-field or subtotal nodal irradiation (STNI) to a total dose of 36-54 Gy, and patients with CMT, received involved-field irradiation to a lower doses, 26-40 Gy. The median follow-up time was 50 months (range 16-180).


RESULTS
The 10-year overall survival (OS) for the whole group was 96% (SE 2%), 100% for stage I, 95% for stage II and 100% for stage III patients. Of potential prognostic factors analysed for statistical significance, only the response to chemotherapy (p=0.0393) was found to influence significantly OS rates. Twelve patients (13.9%) relapsed. Salvage treatment was effective in 10 of the 12 relapsed patients. The 10-year freedom from treatment failure (FFTF) was 79% (SE 6%). Although 8 (9.6%) of the 83 surviving patients developed late effects that could represent toxicity from the treatment, no patient died of late complications.


CONCLUSIONS
RT alone for favourable early stage HD attains good survival rates with a modest treatment related morbidity. For patients with unfavourable stage II and stage III HD, CMT with limited RT provides a good to excellent prognosis.
Zapatero
Almudena
A
Department of Radiation Oncology, Hospital Universitario de la Princesa, Madrid, Spain. azapatero@hlpr.inscelud.es
López
Mario A
MA
Cerezo
Laura
L
De Vidales
Carmen MartIn
CM
MarIn
Alicia
A
Pérez-Torrubia
Armando
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
D000970:Antineoplastic Agents