Mantle irradiation alone for clinical stage I-II Hodgkin's disease: Long-term follow-up and analysis of prognostic factors in 261 patients

Purpose: To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). Patients and Methods:We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994, Pr ognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS), Outcome was also assessed in favorable cohorts d efined in the literature, Results: There were 261 eligible patients, The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only imp ortant prognostic factor The 10-year PFS rate was 58%, On multifactor analy sis for PFS, the most important prognostic factors were clinical stage, a s ymptoms, hislology, number af sites, and tumor bulk. The 10-year PFS rate f or lymphocyte-predominant disease was 81% for stage I and 78% for stage II, In favorable patient cohorts defined in the literature, the 10-year PFS ra te ranged from 70% ta 73% for the whole group and from 71% to 90% in patien ts with favorable stage I disease, but only from 48% to 57% in patients wit h favorable stage II disease, On competing-risks analysis, the cumulative 1 0-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%, Sixty percent of relapsed patients remain progression-fre e at 10 years after chemotherapy salvage. Conclusion: These results support the use of MRT alone in patients with fav orable CS I ND and CS I-II ND with lymphocyte-predominant histology. The re mainder of patients with CS I-II HD require more intensive treatment, J Clin Oncol 17:230-240, (C) 1999 by American Society of Clinical Oncology.