THE MANAGEMENT OF STAGE-I-II HODGKINS-DISEASE WITH IRRADIATION ALONE OR COMBINED MODALITY THERAPY - THE STANFORD EXPERIENCE

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  • 1 January 1982
    • journal article
    • research article
    • Vol. 59  (3) , 455-465
Abstract
At Stanford University, between 1968-1978, 230 patients with pathologic stage I-II Hodgkin''s disease were treated on prospective clinical trials with irradiation alone or irradiation followed by 6 cycles of adjuvant combination chemotherapy [nitrogen mustard, vincristine, procarbazine and prednisone or procarbazine, 1-phenylalanine mustard and vinblastine]. The actuarial survival at 10 yr was 84% for patients in either treatment group. Freedom from relapse at 10 yr was 77% among patients treated with irradiation alone and 84% after treatment with combined modality therapy [P(Gehan) = 0.09]. Freedom from 2nd relapse at 10 yr was 89% and 94%, respectively [P(Gehan) = 0.56]. Several prognostic factors were evaluated to identify patients at high risk for relapse or with poor ultimate survival after initial treatment with irradiation alone. Systemic symptoms, histologic subtype, age and limited extranodal involvement did not affect the prognosis of patients and failed to identify patients whose survival could be improved by the routine use of combined modality therapy. Patients with large mediastinal masses (mediastinal mass ratio .gtoreq. 1/3) had a significantly poorer freedom from relapse when treated with irradiation alone than when treated initially with combined modality therapy [45% vs. 81% at 10 yr, P(Gehan) = 0.03]. The 10 yr survival of these patients was not significantly different (84% vs. 74%). The implications of these observations on the management of patients with early stage Hodgkin''s disease are discussed.