RADIATION-THERAPY FOR EARLY-STAGE HODGKINS-DISEASE - AUSTRALASIAN PATTERNS OF CARE

Purpose: Analysis of treatment outcome for Stage I-IIA supradiaphragma tic Hodgkin's disease treated solely by irradiation in Australia and N ew Zealand. Methods and Materials: Patients with supradiaphragmatic Ho dgkin's disease only who were treated by irradiation alone with curati ve intent between 1969 to 1988 were retrospectively reviewed. Ten radi ation oncology departments in Australia and New Zealand contributed pa tient data to the study. Patient, tumor, and treatment variables were recorded. Disease-free interval, survival, and complications were anal yzed. Results: Eight hundred and twenty patients were reviewed. The me dian age was 29 years. There were 437 men and 383 women. The distribut ion of 310 clinically staged patients was 170 stage IA, 5 IB, and 135 IIA. Five hundred and ten patients received laparotomies, and patholog ic staging was as follows: IA 214, IB 13, IIA. 283. The 10-year actuar ial disease-free rate was 69% and overall survival rate was 79%, Incre asing age, male sex, higher number of involved sites, the use of invol ved field irradiation, no staging laparotomy, and earlier year of trea tment were significantly associated with an increased risk of relapse and lower survival. Actuarial 10-year survival following recurrence wa s 48%. Acute complications requiring interruption to treatment occurre d in 46 patients (6%), but < 1% had their treatment permanently suspen ded. Actuarial complication rates at 10 years were: cardiac 2%, pulmon ary 3% and thyroid 5%, There were 44 second malignancies including 10 non-Hodgkin's lymphomas, 3 leukemias, 7 lung, and 6 breast cancers. Me an delay to the development of a second cancer was 6 years. The 10-yea r actuarial rate of second malignancy was 5%. Conclusions: The Austral asian experience of early stage Hodgkin's disease is consistent with t he results in the published literature and confirms that irradiation p roduces a high cure rate with minimal toxicity.