The therapeutic implications of splenic involvement in stage IIIA Hodgkin's disease

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Abstract
In an effort to determine the most appropriate initial therapy for patients with stage IIIA Hodgkin's disease, a comparative analysis was undertaken of 13 pathologically staged IIIA Hodgkin's disease patients whose abdominal disease was localized to the spleen (III8A); 17 IIIA patients with spleen and abdominal lymph node involvement (III8+n+A) and 44 stage IIA patients. The three groups were treated concurrently with either extended field irradiation alone or limited field irradiation followed by MOPP chemotherapy. Relapse rates after irradiation alone were 17% for the III8A patients; 63% for the III8+n+A patients and 25% for the stage IIA patients. Following therapy with irradiation and chemotherapy no relapses occurred among the III8A and III8+n+A patients while 2/16 (13%) stage IIA patients relapsed. After irradiation alone stage III8+n+A patients had a significantly shorter remission duration and survival than the stage IIA patients (p = 0.03 and 0.002, respectively) but remission duration and survival were similar for the III8A and IIA patients. When therapy was irradiation and chemotherapy no significant differences in remission duration or survival were noted for the three groups. The most common sites of relapse for the III8+n+A patients were extralymphatic (60%) while no extralymphatic relapse have occurred among the IIA patients (p < 0.02). The only relapse among the III8A patients was at an extralymphatic site. These data have shown that patients with III8A Hodgkin's disease have a similar prognosis to stage IIA disease but after therapy with irradiation along stage III8+n+A patients have a poorer prognosis. Combined irradiation and chemotherapy should, therefore, be considered for stage III8+n+A Hodgkin's disease when abdominal nodal disease cannot be included in the initial radiation port.