Stage IA and IIA supradiaphragmatic Hodgkin's disease: Prognostic factors in surgically staged patients treated with mantle and paraaortic irradiation

P. Mauch, N. Tarbell, H. Weinstein, B. Silver, T. Goffman, R. Osteen, A. Zajac, C. N. Coleman, G. Canellos, D. Rosenthal

Research output: Contribution to journalArticle

Abstract

A total of 315 pathologically staged (PS) patients with IA and IIA Hodgkin's disease (HD) were treated with mantle and paraaortic irradiation, and evaluated for freedom-from-first relapse (FFR), survival, prognostic factors, and long-term complications. The 14-year actuarial FFR and survival were 82% and 93%, respectively, with a median follow-up time of 9 years. Mediastinal size was the only factor that predicted for a lower FFR, P < .0001. Forty-nine patients have developed recurrent HD. Thirty-six patients are disease-free following retreatment and only 13 patients have died of HD. Patients with mixed cellularity (MC) histology were more likely to relapse below the diaphragm (11%) as compared with patients with nodular sclerosis (NS) (5.1%) or lymphocyte predominant (LP) (3.6%) histology. These relapses were often associated with bulky pelvic nodal adenopathy, and salvage treatment with chemotherapy alone often failed to control recurrent disease. Alternative diagnostic and therapeutic recommendations are presented for three patients. Thyroid abnormalities represented the most common long-term complication with an actuarial risk at 16 years of 37%. Major complications were rare. Mantle and paraaortic irradiation is associated with a high FFR and a low risk of complications and should remain standard treatment for early-stage HD.

Original languageEnglish (US)
Pages (from-to)1576-1583
Number of pages8
JournalJournal of Clinical Oncology
Volume6
Issue number10
DOIs
StatePublished - Jan 1 1988

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Mauch, P., Tarbell, N., Weinstein, H., Silver, B., Goffman, T., Osteen, R., Zajac, A., Coleman, C. N., Canellos, G., & Rosenthal, D. (1988). Stage IA and IIA supradiaphragmatic Hodgkin's disease: Prognostic factors in surgically staged patients treated with mantle and paraaortic irradiation. Journal of Clinical Oncology, 6(10), 1576-1583. https://doi.org/10.1200/JCO.1988.6.10.1576