2161 Reduction of adverse effects of combined modality therapy with subtotal nodal irradiation in stage IIIA Hodgkin's disease

This is a retrospective analysis of 120 patients with pathologically stage IIIA and IIIB Hodgkin's disease treated from April 1969 to December 1982. The median follow-up was 108 months. Treatment consisted of radiation therapy (RT) alone in 54 patients and combined radiation therapy and MOPP (nitrogen mustard, vincristine, procarbazine, prednisone) chemotherapy (CMT) in 66 patients. Stage III patients treated with CMT have an improved actuarial 12-year survival as compared with patients treated with RT alone with MOPP reserved for relapse (80% v 64%; P = .026). The 12-year actuarial freedom from first relapse by treatment for stage III patients is 83% and 40%, respectively (P less than .0001). Improved survivals following combined modality therapy are seen for the following subgroups of stage III patients: stage III2, 66% (CMT) v 44% (total nodal irradiation; TNI), P = .04; stage III1, 97% (CMT) v 73% (TNI), P = .05; stage III mixed cellularity or lymphocyte depletion histology, 94% (CMT) v 65% (TNI), P = .007; and stage III extensive splenic involvement, 77% (CMT) v 58% (TNI), P = .02. These survival differences are not seen in patients with nodular sclerosis or lymphocyte predominance histology or in patients with minimal splenic involvement. These data indicate that the initial use of CMT in stage III Hodgkin's disease results in an improved survival as compared with initial treatment with RT with MOPP reserved for relapse. Patients with limited Stage IIIA disease may still be candidates for radiation therapy alone.

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Chemotherapy alone versus combined modality therapy for Stage III Hodgkin’s disease: A five-year follow-up of a Southwest Oncology Group study (SWOG-7518) USA

Malignant Lymphomas and Hodgkin’s Disease: Experimental and Therapeutic Advances ◽

10.1007/978-1-4613-2607-6_36 ◽

1985 ◽

pp. 345-351 ◽

Cited By ~ 1

Author(s):

P. N. Grozea ◽

E. J. Depersio ◽

C. A. Coltman ◽

C. J. Fabian ◽

F. S. Morrison ◽

...

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Combined Modality Therapy ◽

Stage Iii ◽

Oncology Group ◽

Oncology Group Study ◽

Southwest Oncology Group ◽

Combined Modality ◽

Southwest Oncology Group Study

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Stage IIB Hodgkin's disease: the Stanford experience.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.4.472 ◽

1986 ◽

Vol 4 (4) ◽

pp. 472-479 ◽

Cited By ~ 23

Author(s):

M J Crnkovich ◽

R T Hoppe ◽

S A Rosenberg

Keyword(s):

Relapse Rate ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Combined Modality Therapy ◽

Survival Rates ◽

Actuarial Survival ◽

Combined Modality ◽

Significant Difference ◽

Ann Arbor ◽

The Impact

Between 1968 and 1982, 126 patients with pathologic stage (PS) IIB Hodgkin's disease were treated at Stanford University with either irradiation alone or irradiation combined with chemotherapy. Actuarial survival and freedom from relapse rates at 10 years for the overall group were 81% and 74% respectively, with no statistically significant difference between the treatment approaches. The impact of the severity and number of constitutional (B) symptoms, as defined by the Ann Arbor Conference, was analyzed. Patients who presented with all three B symptoms had significantly poorer survival and freedom from relapse compared with those patients with only one or two B symptoms (for survival differences, P = .005 and .007; for freedom from relapse differences, P = .002 and .04). Male sex was the only other prognostic factor that correlated with a poor outcome. At 10 years, the survival rate was 66% for males v 84% for females (P = .01), and the freedom from relapse rate was 75% for males v 89% for females (P = .02). The presence of extralymphatic sites of involvement, age greater than 40, or involvement of greater than three lymphoid sites had no significant adverse effect on either freedom from relapse or survival. Patients with large mediastinal masses treated with irradiation alone had a 10-year freedom from relapse rate of 54% v 81% for those treated with combined-modality therapy (P = .15), but there was no significant difference in survival rates (85% for irradiation alone v 71% for combined modality therapy). Treatment recommendations for stage IIB Hodgkin's disease are discussed.

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