Treatment of stage I and II mediastinal Hodgkin disease. A comparison of involved fields, extended fields, and involved fields followed by MOPP in patients staged by laparotomy.

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Abstract
Three treatment programs for Stage I and II mediastinal Hodgkin disease (established by laparotomy) were compared. Involved-field radiotherapy + MOPP [mechlorethamine, vincristine, procarbazine, prednisone] gave a disease-free survival rate of 97%, significantly different from 62 and 55% for involved and extended fields, respectively. Corresponding survival figures of 97, 88 and 84% were not significantly different statistically due to salvage with radiotherapy and/or chemotherapy. Among patients given radiotherapy alone, the survival figure of 94% for limited mediastinal disease was significantly better than 63% for extensive mediastinal and hilar disease; corresponding disease-free figures of 72 and 35% were also significantly different. Constitutional symptoms were an important prognostic factor in disease-free survival following the use of involved fields; hilar disease was important only with large mediastinal masses. Most relapses were intrathoracic; MOPP alone salvaged only 47%. Treatment of Stage I and II Hodgkin disease should be based on symptoms, extent of mediastinal disease and hilar involvement.