HODGKINS-DISEASE STAGE-I AND STAGE-II WITH EXCLUSIVE SUBDIAPHRAGMATICPRESENTATION - THE EXPERIENCE OF THE DEPARTMENTS OF RADIATION ONCOLOGY AND HEMATOLOGY, UNIVERSITY LA SAPIENZA OF ROME

During the period 1978 to 1994, 1054 patients with Hodgkin's disease w ere evaluated and treated at the Departments of Radiation Oncology and Hematology, University ''La Sapienza'', Rome, A total of 549 patients presented with clinical or pathological stage I and II; 37 of these h ad Hodgkin's disease below the diaphragm (BDHD), and 512 above the dia phragm (ADHD), A comparison of patients with BDHD versus those with AD HD showed that the first group had a higher male to female ratio, A co mparison of cases with stage II BDHD versus those with stage II ADHD s howed that patients with BDHD were older (48 years vs 28 years), had d ifferent histologic features and a higher incidence of systemic sympto ms (67% vs 33%). Stage II BDHD patients had a worse prognosis; in fact , there were significant differences in the overall survival and relap se-free-survival rates for cases with stage II BDHD versus those with stage II ADHD (overall survival, 46% vs 80%, P<0.001; relapse-free sur vival, 44% vs 69%, P<0.005). Stage was found to be the most important prognostic factor for BDHD cases without systemic symptoms treated wit h radiation therapy alone. The type of infradiaphragmatic presentation (intra-abdominal vs peripheral disease) did not Influence outcome, pr obably due to the more aggressive therapy received by the intra-adbomi nal group, Treatment recommendations for BDHD cases should be tailored to the stage and the presence or absence of intra-abdominal localizat ion. For patients with stage IA extended fields, irradiation (inverted Y) is sufficent, However, combined modality therapy should be the tre atment of choice for stage ii cases, particularly in the presence of i ntra-abdominal disease. Patients with systemic symptoms also require c ombined modalities.