Follow-Up of Pathological Stage I and IIA Supradiaphragmatic Hodgkin's Disease Primarily Treated with Radiotherapy

One hundred and fifty-five consecutive previously untreated adult patients with supradiaphragmatic pathologic stage IA (71) and IIA (84) Hodgkin's disease treated only with radiotherapy (RT) at the Istituto Nazionale Tumori of Milano from 1970 to 1978 were reviewed. Staging procedures included lymphangiography and laparotomy in all cases. Most patients were irradiated with a conventional cobalt machine. Mantle fields were adopted for 36.8% of cases, mainly at stage I, whereas 63.2% received mantle plus paraaortal irradiation. Doses were above 40 Gy for involved sites and 35–40 Gy for prophylactically irradiated nodes. Minimum and median follow-up were 30 months and 6 years, respectively. All patients achieved complete remission at the end of RT. As of June 1981, 89 of 155 patients (57.5%) were alive and free from progression, 60.6% at stage I, and 54.8% at stage II. Relapses occurred in 54 of 155 cases (35%) after a median free interval of 21 months. Marginal recurrences accounted for 5.8%, true recurrences for 9%, nodal extensions for 8.4%, and extranodal extensions for 11.6%. Males older than 40 years and mediastinal involvement were correlated with higher relapse rates. Salvage treatment consisted of RT alone in 8 patients and chemotherapy plus or minus RT in 44, whereas 2 patients died before a new treatment could start. As of June 1981, 38 of 54 relapsed patients (70.4%) were alive and disease free, whereas 2 were alive with evidence of disease. Actuarial overall survival at 6 years was 90.3% for all cases, 97.1% for stage I, and 84.8% for stage II. Treatment toxicity was analyzed, and problems concerning surgical staging procedures, optimal RT and role of chemotherapy as primary or salvage treatment were discussed.

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Mantle Irradiation Alone for Clinical Stage I-II Hodgkin's Disease: Long-Term Follow-Up and Analysis of Prognostic Factors in 261 Patients

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.1.230 ◽

1999 ◽

Vol 17 (1) ◽

pp. 230-230 ◽

Cited By ~ 21

Author(s):

A. Wirth ◽

M. Chao ◽

J. Corry ◽

C. Laidlaw ◽

K. Yuen ◽

...

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

Progression Free Survival ◽

Stage I ◽

Stage Ii ◽

Multifactor Analysis

PURPOSE: To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). PATIENTS AND METHODS: We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994. Prognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS). Outcome was also assessed in favorable cohorts defined in the literature. RESULTS: There were 261 eligible patients. The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only important prognostic factor. The 10-year PFS rate was 58%. On multifactor analysis for PFS, the most important prognostic factors were clinical stage, B symptoms, histology, number of sites, and tumor bulk. The 10-year PFS rate for lymphocyte-predominant disease was 81% for stage I and 78% for stage II. In favorable patient cohorts defined in the literature, the 10-year PFS rate ranged from 70% to 73% for the whole group and from 71% to 90% in patients with favorable stage I disease, but only from 48% to 57% in patients with favorable stage II disease. On competing-risks analysis, the cumulative 10-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%. Sixty percent of relapsed patients remain progression-free at 10 years after chemotherapy salvage. CONCLUSION: These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.

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Results of a Prospective Trial of Mantle Irradiation Alone for Selected Patients With Early-Stage Hodgkin’s Disease

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.3.736 ◽

2001 ◽

Vol 19 (3) ◽

pp. 736-741 ◽

Cited By ~ 12

Author(s):

Kendall H. Backstrand ◽

Andrea K. Ng ◽

Ronald W. Takvorian ◽

Ellen L. Jones ◽

David C. Fisher ◽

...

Keyword(s):

Hodgkin's Disease ◽

Early Stage ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

Prospective Trial ◽

Stage I ◽

Mixed Cellularity ◽

European Organization ◽

Extended Field

PURPOSE: To determine the efficacy of mantle radiation therapy alone in selected patients with early-stage Hodgkin’s disease. PATIENTS AND METHODS: Between October 1988 and June 2000, 87 selected patients with pathologic stage (PS) IA to IIA or clinical stage (CS) IA Hodgkin’s disease were entered onto a single-arm prospective trial of treatment with mantle irradiation alone. Eighty-three of 87 patients had ≥ 1 year of follow-up after completion of mantle irradiation and were included for analysis in this study. Thirty-seven patients had PS IA, 40 had PS IIA, and six had CS IA disease. Histologic distribution was as follows: nodular sclerosis (n = 64), lymphocyte predominant (n = 15), mixed cellularity (n = 3), and unclassified (n = 1). Median follow-up time was 61 months. RESULTS: The 5-year actuarial rates of freedom from treatment failure (FFTF) and overall survival were 86% and 100%, respectively. Eleven of 83 patients relapsed at a median time of 27 months. Nine of the 11 relapses contained at least a component below the diaphragm. All 11 patients who developed recurrent disease were alive without evidence of Hodgkin’s disease at the time of last follow-up. The 5-year FFTF in the 43 stage I patients was 92% compared with 78% in the 40 stage II patients (P = .04). Significant differences in FFTF were not seen by histology (P = .26) or by European Organization for Research and Treatment of Cancer H-5F eligibility (P = .25). CONCLUSION: Mantle irradiation alone in selected patients with early-stage Hodgkin’s disease is associated with disease control rates comparable to those seen with extended field irradiation. The FFTF is especially favorable among stage I patients.

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Histology as a Prognostic Factor in 100 Cases of Hodgkin's Disease

Tumori Journal ◽

10.1177/030089166605200606 ◽

1966 ◽

Vol 52 (6) ◽

pp. 451-464 ◽

Cited By ~ 7

Author(s):

Sergio Di Pietro ◽

Federico Pizzetti

Keyword(s):

Prognostic Factor ◽

National Cancer Institute ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

The Third ◽

Nodular Sclerosis ◽

At Iii ◽

Mediastinal Involvement

The paper deals with 100 cases of Hodgkin's disease, treated at the National Cancer Institute of Milan from 1949 to 1958, all submitted to clinical follow-up until the end of November 1966 or death. Histologically, the 100 cases were grouped as follows: 14 paragranulomas, 15 nodular scleroses, 49 polymorphous granulomas and 22 Hodgkin's sarcomas. Paragranulomas showed the best average median and 10-year survivals, nodular sclerosis the best 5-year survivals; Hodgkin's sarcomas showed the worst clinical evolution, without 10-year survivals. The behaviour of the disease was found to be more unfavourable in the third and fourth decades of life, more favourable in the fifth decade. In men the evolution was slower, after an initial unfavourable course; no 10-year survival was observed in women. Nodular sclerosis prevailed in early diagnosed patients, paragranuloma and Hodgkin's sarcoma in late diagnosed cases. Eighty-eight of the 100 patients were at III and IV clinical stage at admission, only 12 at I or II stage. Nearly all cases of nodular sclerosis concerned patients at the III stage, with mediastinal involvement; Hodgkin's sarcoma was more frequent in patients at the IV stage. Five-year survival at the IV stage was observed only in patients with paragranuloma or nodular sclerosis; these two histological types prevailed also in patients without general symptoms. Polymorphous granuloma and Hodgkin's sarcoma were more frequent in patients with general symptoms.

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2163 Subdiaphragmatic stage I & II Hodgkin's disease-long-term follow-up and prognostic factors

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(97)80930-3 ◽

1997 ◽

Vol 39 (2) ◽

pp. 322

Author(s):

Zhongxing Liao ◽

Chul S. Ha ◽

Lillian M. Fuller ◽

Fredrick B. Hagemeister ◽

Fernando Cabanillas ◽

...

Keyword(s):

Prognostic Factors ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Stage I ◽

Long Term Follow Up

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The adjuvant role of two cycles of MOPP and low-dose lung irradiation in stage ia through iib hodgkin's disease: Preliminary results

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(88)90090-9 ◽

1988 ◽

Vol 14 (4) ◽

pp. 683-692 ◽

Cited By ~ 21

Author(s):

Lillian M. Fuller ◽

Fredrick B. Hagemeister ◽

Luceil B. North ◽

Peter McLaughlin ◽

William S. Velasquez ◽

...

Keyword(s):

Hodgkin's Disease ◽

Low Dose ◽

Hodgkin’S Disease ◽

Preliminary Results ◽

Stage Ia ◽

Lung Irradiation

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Serum Cytokine in Response to Chemo-Radiotherapy for Hodgkin's Disease

Tumori Journal ◽

10.1177/030089160809400605 ◽

2008 ◽

Vol 94 (6) ◽

pp. 803-808 ◽

Cited By ~ 14

Author(s):

Fabrizio Villani ◽

Alessandra Busia ◽

Massimiliano Villani ◽

Chiara Vismara ◽

Simonetta Viviani ◽

...

Keyword(s):

Lung Function ◽

Serum Concentration ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Combined Treatment ◽

Lung Toxicity ◽

Multiple Drug ◽

Tgf Beta

Aims and Background Mediastinal radiotherapy and multiple-drug chemotherapy, including bleomycin employed in the treatment of Hodgkin's disease, can produce lung toxicity leading to fibrosis. There is increasing evidence of the involvement in the fibrosing process of different cytokines and growth factors such as TNF-alfa, IL-1 beta, TGF-beta and PDGF. Material and Methods In a pilot study, we evaluated lung function in 20 patients suffering from Hodgkin's disease, mainly in stage II A, submitted to multiple-drug chemotherapy including bleomycin (ABVD) and mediastinal radiotherapy and correlated its modifications with serum concentration of the cytokines determined by immunoenzymatic assay. Spirometry and transfer lung function for carbon monoxide (DLCO) were performed before, at the end of chemotherapy, at the end of radiotherapy and after a follow-up of 6 and 12 months. Results DLCO decreased at the end of the combined treatment and then remained constantly decreased. TNF-alfa, TGF-beta and PDGF-alfa concentrations did not change, whereas IL-1 beta significantly increased after the completion of the combined treatment and after a follow-up of 6–months and then declined to normal values after 12 months. The serum concentration of the cytokine was significantly higher in patients who had a DLCO <75% of predicted after 1 year than in patients with a DLCO >75%. Conclusions The results indicate a potential role of IL-1 beta in the pathogenesis of chemoradiotherapy-induced lung toxicity, which needs to be confirmed in a larger patient population.

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