title: Early stage infradiaphragmatic Hodgkin's disease: results of radiotherapy and review of the literature.
abstract: OBJECTIVE
  To assess the impact of modality therapy on long-term outcome for infradiaphragmatic Hodgkin's disease (IDHD).
  
  
  METHODS
  During the period 1965-1997, 847 patients with early stage Hodgkin's disease (HD) were evaluated and treated at our institution, 20 of them had IDHD (2.4%). Patients characteristics: stage I, nine patients (five pathological stage (PS), and four clinical stage (CS)) and stage II: 11 patients (six PS and five CS). Two modalities of treatment were used: combined modality (CMT), consisting of chemotherapy followed by extended field radiotherapy or radiotherapy alone (XRT). All patients with CS or PS II, except in one case, were treated with CMT. Overall, 12 patients were treated with CMT and the remaining eight patients were treated with XRT.
  
  
  RESULTS
  The relapse rate after initial treatment was 30%. Ten-year disease free survival (DFS) and 10-year cause-specific survival were 60% and 92%, respectively. There was a non-significant trend to a better DFS for the CMT group of patients (76% vs. 35% for the whole series and 100% vs. 24% for stage I patients). The four relapsed patients in the XRT group were inguino-femoral PS I. In four out of the six patients who relapsed (66%) the failure was located solely in the supradiaphragmatic area, outside of the radiation fields.
  
  
  CONCLUSIONS
  In our experience, inguino-femoral stage I patients have a high relapse rate after XRT; consequently, CMT consisting of chemotherapy plus involved field radiotherapy should be recommended for early stage HD confined below diaphragm.
authors.affiliation: Department of Radiation Oncology, Hospital Universitario Puerta de Hierro, San Martin de Porres 4, 28035 Madrid, Spain.
authors.forename: Sofía
authors.initials: S
authors.lastname: Córdoba
authors.forename: Jésus
authors.initials: J
authors.lastname: Romero
authors.forename: Alejandro
authors.initials: A
authors.lastname: De la Torre
authors.forename: Francisco
authors.initials: F
authors.lastname: Valcárcel
authors.forename: Rosa
authors.initials: R
authors.lastname: Magallón
authors.forename: Carlos Alfonso
authors.initials: CA
authors.lastname: Regueiro
authors.forename: María Isabel
authors.initials: MI
authors.lastname: García-Berrocal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003964:Diaphragm; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies