THE ROLE OF PROGNOSTIC FACTORS IN TREATMENT SELECTION FOR EARLY-STAGEHODGKINS-DISEASE

Purpose: To identify poor prognostic factors in early-stage Hodgkin's disease that predict a high rate of relapse after radiotherapy alone. Materials and Methods: A total of 153 patients with stages I and II su pradiaphragmatic Hodgkin's disease, treated between 1964 and 1986 with either radio-therapy alone (120 patients) or combined modality therap y (33 patients), were studied retrospectively to determine factors aff ecting freedom from relapse and absolute survival. Median follow-up wa s 13 years. Clinical factors were assessed by the stepwise use of a st ratified log-rank test and included maximum tumor dimension in any sit e (less-than-or-equal-to 6 cm or >6 cm), age (less-than-or-equal-to 40 or >40), presence or absence of B symptoms, pathologic and clinical s tages (I or II), number of sites involved (less-than-or-equal-to 4 or >4), gender, histologic subtype, and large mediastinal mass (none, sma ll [less-than-or-equal-to 6 cm], large [>6 cm]). Results: The only fac tors independently predicting a high rate of relapse were tumor dimens ion (>6 cm) and number of sites (>4 sites). At 10 years, in patients w ith and without the two poor prognostic factors treated with radiother apy alone, the freedom from relapse rates were 5 3% and 84% (p < .0001 ) and the absolute survival rates were 72% and 85% (p = .004), respect ively. Combined modality therapy significantly improved freedom from r elapse, but not absolute survival, in patients with one or both poor p rognostic factors. Conclusions: Two poor prognostic factors were ident ified that were highly significant in predicting a high risk of relaps e after radiotherapy alone. The addition of three cycles of chemothera py to standard radiotherapy significantly reduced the relapse rate in high-risk patients.