SIMULTANEOUS SUPRADIAPHRAGMATIC AND INFRADIAPHRAGMATIC IRRADIATION INHODGKINS-DISEASE

From 1982 to 1989, 68 patients with Stages IA to IIIB Hodgkin's diseas e were treated by simultaneous supra- and infradiaphragmatic irradiati on (SSI-RT). 46 patients received exclusive radiotherapy for Stages IA and IIA (extended mantle field irradiation (EMF) 31, and total lympha tic irradiation (TLI) 15). Combined modality treatment including pre-i rradiation chemotherapy, was given to 22 patients (CH-EMF 12 and CH-TL I 10). The median follow-up was 64 months. 5-year overall survival was 94% in combined Stages IA and IIA, and 100% in Stage IIIA. 5-year fre edom from relapse was 87% in combined Stages IA and IIA, and 80% in St age IIIA. Toxicity was evaluated in 64 patients. Acute and long term t oxicity was similar to previously reported data on sequential supra- a nd infradiaphragmatic irradiation. In SSI-RT prior chemotherapy affect ed pre-irradiation blood counts and was associated with delayed post-i rradiation haematological recovery. The relative mean white blood cell (WBC) decrease ranged from 47% (EMF) to 61 % (TLI). The mean platelet decrease ranged from 43% (EMF) to 80% (CH-TLI). Both prior chemothera py and total lymphoid irradiation increased haematotoxicity. The mean duration of breaks ranged from 3.9 days in EMF to 14.9 days in CH-TLI. The mean treatment time, ranging from 43 days in EMF to 54 days in TL I, was significantly shorter than in sequential schedules (up to 112 d ays). Our results indicate that SSI-RT is an effective and safe treatm ent. Its use seems to be limited mainly by prior chemotherapy. As comp ared to sequential schedules, the risk of match line overlap is avoide d, overall treatment time is decreased, and treatment costs are minimi zed.