EXTENDED-FIELD RADIOTHERAPY IN FAVORABLE STAGE IA-IIA HODGKINS-DISEASE (PROGNOSTIC ROLE OF STAGE)

Purpose: The study was undertaken to evaluate the long-term results in a favorable subset of patients with pathological Stage IA-IIA treated with irradiation alone. Methods and Materials: One hundred and forty- seven adults with laparotomy- Staged IA-IIA ''favorable'' Hodgkin's di sease were treated with primary subtotal nodal irradiation. Patients w ith infradiaphragmatic presentation were irradiated through paraortic and inguino-iIiac node chains (inverted Y field) followed by prophylac tic mediastinal and supraclavicular fields. Results: Actuarial overall survival (OS) at 7 years (median follow-up 77 months) was: 93% for th e whole series, 94% for Stage I, and 92% for Stage II. The freedom fro m first progression (FFP) (80% for the whole series) showed a statisti cally significant difference (p = 0.008) between Stage I (88%) and Sta ge II (71%). By univariate analysis, stage alone had an independent pr ognostic significance for OS and FFP. Of the 29 relapsed patients, 8 w ere previously classified as Stage I and 21 as Stage II; 16 of 29 (55% ) of the relapses occurred in the pelvis and 9 in extranodal sites. Af ter salvage treatment with chemotherapy all patients achieved a second complete remission. Seven second malignancies (two acute nonlymphocyt ic leukemias, one preleukemic syndrome, and four solid tumors) have be en detected so far. Hypothyroidism was observed in 16% of patients and a reversible pulmonary restrictive syndrome in 14% of cases, respecti vely. Conclusions: Within 7 years from radiation therapy, about one-qu arter of the patients with Stage II disease will experience a relapse and need intensive salvage chemotherapy. This is not invariably succes sful and safe, for it may be complicated by either acute or potentiall y fatal long-term adverse effects, such as second malignancies and car diac or pulmonary sequelae, in about 5% of patients. The high frequenc y of relapse in Stage IIA patients suggests a combined modality approa ch with relatively short-term chemotherapy not including alkylating ag ents.