TREATMENT OF SUBDIAPHRAGMATIC HODGKINS-DISEASE - IS RADIOTHERAPY ALONE APPROPRIATE ONLY FOR INGUINO-FEMORAL PRESENTATIONS

Purpose: Evaluate the role of staging laparotomy, and the impact of di sease subsites on treatment outcome, for sub-diaphragmatic Hodgkin's D isease. Methods and Materials: Between 1966 and 1989, 23 patients with Hodgkin's disease limited to sites below the diaphragm were treated a t the Royal Adelaide Hospital. The high male:female ratio (2:8), low p roportion of nodular sclerosis subtype (26%), and older age (mean = 40 ) relative to supra-diaphragmatic Hodgkin's disease is consistent with most other series. Thirteen patients underwent staging laparotomy. In itial treatment consisted of radiation therapy alone in 11, chemothera py alone in 7, and combined modality therapy in 3 patients. This data was then combined with other published series over the last decade, to analyse relapse patterns and treatment results in relation to initial site(s) of disease. Results: The overall, disease specific, and progr ession free 5 (and 10) year survival rates were 69%, 81%, and 58% resp ectively. There was no statistically significant effect of staging lap arotomy 69 any of these parameters. Combining these results with those in the literature revealed an unacceptable relapse rate for patients with disease outside of the inguino-femoral region treated with invert ed-ii radiation therapy alone. Conclusions: For the majority of patien ts with sub-diaphragmatic Hodgkin's disease, staging laparotomy can be avoided. Inverted-Y radiation therapy should only be used for inguino -femoral presentations.