MANTLE IRRADIATION ALONE FOR SELECTED PATIENTS WITH LAPAROTOMY-STAGEDIA TO IIA HODGKINS-DISEASE - PRELIMINARY-RESULTS OF A PROSPECTIVE TRIAL

Purpose: To determine the feasibility of omitting prophylactic paraaor tic irradiation in selected patients with laparotomy-staged (pathologi cally staged [PS]) IA to IIA Hodgkin's disease. Patients and Methods: We initiated a prospective single-arm trial in October 1988 to study t he role of mantle irradiation alone in selected PS IA to IIA patients with Hodgkin's disease. A total of 37 patients have been entered onto this trial. Entrance criteria included nodular sclerosis (NS) or lymph ocyte predominance (LP) histology, absence of B symptoms, disease limi ted above the carina, and a negative laparotomy. Results of treatment of 23 patients in the prospective trial, monitored off treatment for g reater than or equal to 1 year, are presented. Twenty-three additional PS IA to IIA patients, treated with mantle irradiation alone from 197 0 to 1987, were analyzed as a comparison group. The median follow-up d urations were 32 and 113 months, respectively, for the two groups. Res ults: The 4-year actuarial rates of freedom from relapse and overall s urvival are 83% and 100%, respectively, for the prospective trial. The 10-year actuarial rates of freedom from relapse and overall survival ore 83% and 89%, respectively, for retrospectively studied patients. T here have been five recurrences among 46 patients who received mantle irradiation alone, all with a component of relapse below the diaphragm . Conclusion: These early results support the use of mantle irradiatio n alone in selected PS IA to IIA patients with NS or LP histology. Rel apses, although rare, have occurred predominantly below the diaphragm. This suggests the need for continued long-term surveillance of abdomi nal and pelvic nodes in this group of treated patients. J Clin Oncol 1 3:947-952. (C) 1995 by American Society of Clinical Oncology.