IMPROVED SURVIVAL IN PATIENTS WITH LIMITED STAGE IIIA HODGKINS-DISEASE TREATED WITH COMBINED RADIATION-THERAPY AND CHEMOTHERAPY

Purpose: Patients with laparotomy-staged (PS) III1A Hodgkin's disease confined to the upper abdomen are believed to have a favorable prognos is and require less aggressive treatment than patients with more-exten sive stage III disease. We evaluated prognostic factors and outcome in 93 patients with PS III1A Hodgkin's disease treated either with radia tion therapy (RT) alone or combined RT and chemotherapy (combined moda lity treatment [CMT]) to determine the extent of treatment needed in t his subgroup of stage IIIA patients. Materials and Methods: We retrosp ectively reviewed the freedom from relapse (FFR) rate, sites of recurr ence, and survival rate of PS III1A patients selected to receive exten ded-field irradiation (MPA, n = 27), total-nodal irradiation (TNI, n = 34), and CMT (n = 32) between 1969 and 1987. CMT consisted of six cyc les of mechlorethamine, vincristine, procarbazine, and prednisone (MOP P) chemotherapy and MPA. Patients treated with MPA were part of ct pro spective trial designed to reduce treatment to patients with minimal s tage III disease with very favorable characteristics. Results: Histolo gic subclass and treatment were the only prognostic factors for FFR an d survival rates. Patients with nodular sclerosis or lymphocyte predom inance histology had significantly higher FFR and survival rates compa red to patients with mixed-cellularity (MC) histology. The 10-year act uarial FFR of PSIII1A patients treated with MPA was only 39%, versus 5 5% for TNI (P =.02) and 94% for CMT (v MPA, P <.0001; v TNI, P = .006) . The patterns of recurrence in patients who received MPA and TNI were significantly different, with MPA patients relapsing more often in un treated pelvic or inguinal nodes, and TNI patients relapsing more ofte n in extranodal sites with or without nodal sites. The 10-year actuari al overall survival rate for patients treated with CMT was 89% versus 78% for MPA (v CMT, P =.09) and 70% for TNI (v CMT, P =.05). Conclusio n: Patients with PSIII1A Hodgkin's disease treated with PT have a sign ificantly higher risk of relapse and potentially a poorer survival com pared with patients treated with CMT. These findings suggest that CMT should play a greater role in the treatment of this favorable substage of patients. Management with modified chemotherapy and PT in an attem pt to reduce long-term treatment-induced complications may be a prefer red approach for future trials. (C) 1994 by American Society of Clinic al Oncology.