HODGKINS-DISEASE PRESENTING BELOW THE DIAPHRAGM - THE EXPERIENCE OF THE GRUPPO-ITALIANO-STUDIO-LINFOMI (GISL)

Background and Objective. Infradiaphragmatic Hodgkin's disease is rare , making up 5-12% of cases in clinical stages I and II; consequently, several questions concerning prognosis and treatment strategy remain t o be answered. The aim of this study was to analyze the clinical and p rognostic characteristics and outcome of his condition. Methods. A ser ies of 282 patients with CS I-II Hodgkin's disease (HD) was investigat ed. In 31 patients the disease was confined below the diaphragm (BDHD) , and in the remaining above the diaphragm (ADHD). The presenting feat ures and outcomes were compared in the two groups. Results. The BDHD g roup was older (p < 0.0002), had a higher frequency of males (p < 0.08 ) and a different histological subtype group distribution (p < 0.0001) . Stage II BDHD patients had a worse overall survival rate (OS) than s tage II ADHD patients (68.8% vs 86.6% at 8 years, p < 0.01) if age is not considered; patients with more than 40 years of age, in fact, had the same survival rates as those with ADHD. BDHD patients with intra-a bdominal disease alone had worse prognostic factors and OS (p = 0.12) than patients with inguinal-femoral nodes. Interpretation and Conclusi ons. Although BDHD patients present distinct features, they have the s ame OS and relapse-free survival rate as age-adjusted ADHD patients. A ccording to our experience patients with stage I peripheral BDHD respo nd well to radiotherapy-based regimens. Those with stage II and or int ra-abdominal disease are more challenging; chemotherapy or a combined therapy seem to be more suitable approaches for these patients. (C) 19 97, Ferrata Storti Foundation.