HODGKINS-DISEASE WITH BULKY MEDIASTINAL INVOLVEMENT - EFFECTIVE MANAGEMENT WITH COMBINED MODALITY THERAPY

Purpose: To assess results, complications, treatment techniques, and p atterns of failure in patients with bulky mediastinal Hodgkin's diseas e treated with combined modality therapy. Methods and Materials: Betwe en 1980 and 1988, 48 patients with Hodgkin's disease who had large med iastinal masses were treated at Stanford University. All patients were staged with clinical studies which included computed tomographic scan s of the chest and bipedal lymphograms. Initially, 10 patients underwe nt staging laporotomy and splenectomy, subsequently all patients were staged by clinical criteria alone. Mediastinal mass ratios ranged from 35 to .85 (mean .46). The majority of patients had at least one site of extralymphatic extension (E-lesion) within the chest. Combined moda lity therapy included MOPP (prednisone deleted after mediastinal irrad iation) in 15, ABVD in 14, and PAVe in 19 patients. All patients recei ved mantle irradiation (mean dose 44 Gy) but only patients with abdomi nal disease received subdiaphragmatic irradiation. Results: The actuar ial survival and freedom from relapse were 84% and 88% at 9 years. The re was an intrathoracic component of failure in all seven patients who either failed to achieve an initial complete response or who experien ced a relapse after a complete response. Both patients who experienced a relapse after a complete response achieved durable second responses with subsequent chemotherapy. Two of five patients who failed to achi eve an initial complete response were treated successfully with altern ative chemotherapy. Conclusions: Routine combined modality therapy is the treatment of choice for patients with Hodgkin's disease who have l arge mediastinal masses.