Results of the 1988-1989 patterns of care study process survey for Hodgkin's disease

Purpose: To document national standards of care for patients receiving radi otherapy as part of curative treatment for Hodgkin's disease. Materials and Methods: A national survey was conducted of 61 institutions t reating 275 patients with Stages I-III Hodgkin's disease and representing s ix facility type strata. Pretreatment evaluation, radiotherapy treatment pa rameters, and use of combined modality therapy were assessed. Results: Ann Arbor stage for the 275 patients was as follows: IA, 69 (25%); IB, 7 (3%); IIA, 123 (45%); IIB, 36 (13%); IIIA 23 (8%), IIIB, 14 (5%); un known, 3 (1%). Pretreatment evaluation included complete blood count for 93 %, sedimentation rate in 29%, chest CT in 88%, abdominal CT scan in 87%, an d bone marrow biopsy in 81%. Lymphangiograms were obtained in 50% of cases; laparotomy was performed in 46%. The yield of positive findings in the spl een at laparotomy was 6.5% overall. Facility differences with respect to st aging were seen only for the use of gallium scans, which were more commonly used in academic centers (44% vs. 15-23% elsewhere, p < 0.001). Radiothera py was delivered with a linear accelerator in 94% of cases. Treatment simul ation was performed for 94% and individualized blocks constructed for 95% o verall; however, freestanding facilities had a lower rate of performance of these procedures (78% vs. 98-99% for simulation and 88% vs. 96-99% for cus tomized blocking, p < 0.001). The mean supradiaphragmatic dose was 36.74 Gy and the mean subdiaphragmatic dose was 33.81 Gy. Planned combined modality therapy was given in 36% of patients. The use of combined modality therapy by stage was as follows: IA, 11%; IB, 43%; IIA, 30%; IIB, 68%; IIIA, 57%; IIIB, 100%. Chemotherapy was completed prior to radiation in 80% of cases a nd generally consisted of ABVD (32%), an alternating regimen (25%), or MOPP (22%). Among Stage VII patients, use of chemotherapy was associated with r educed radiation doses (mean supradiaphragmatic dose 34.53 Gy vs. 38.43 Gy and mean subdiaphragmatic dose 31.27 Gy vs. 34.51 Gy), and reduced volumes of treatment (87% vs. 28% treated to one side of the diaphragm only). Lapar otomy was not associated with decreased supra- or subdiaphragmatic radiatio n doses or decreased volumes of treatment. Conclusions: With the exception of gallium scans, pretreatment evaluation i s relatively uniform across facility strata. Increased understanding of pro gnostic factors in Hodgkin's disease and greater use of planned combined mo dality therapy for higher risk patients appears to have contributed to a de creased use of and low yield of positive findings for laparotomy. Laparotom y was not associated with reduced radiation volumes or doses. Freestanding radiation facilities had a lower rate than other facility types for the per formance of treatment simulation and customized patient blocking. (C) 1999 Elsevier Science Inc.