Treatment of nonlaparotomized (clinical) stage I and II Hodgkin's disease patients by extended field and splenic irradiation

Purpose: At the New York Presbyterian Hospital-Cornell Medical Center, pati ents with unequivocal clinical stage I and IIA Hodgkin's disease (HD) have been treated with mantle, splenic, and extended field radiation therapy (EF RT) (without surgical staging). A 24-year retrospective review was conducte d to determine the effectiveness of our patient selection on the outcome of patients treated with this modality, Methods and Materials: During the period 1971 to 1993, 94 patients with cli nically staged HD, with favorable prognostic factors, were retrospectively reviewed, Patients with pathological or equivocal staging, "B" symptoms, bu lk disease, history of previous chemotherapy, and/or Stage III or IV diseas e were excluded from our analysis. There were 27 Stage IA and 67 Stage IIA patients, All patients were treated to 3600 cGy with a 400 cGy boost to the involved field, The median follow-up was 52 months, mean of 62.1 months. Results: Ten of 94 patients (10.5 %) relapsed. Seven of the relapses were i n the pelvis, one submandibularily, one in the tonsil, and one in the axill a, Nine of the relapses had nodular sclerosis histology, one had lymphocyte predominance, and none had mixed cellularity, The median time to relapse w as 38 months; mean time 42.3 months. All patients are alive, well and free of disease, including nine who received subsequent chemotherapy and one who underwent autotransplantation, Conclusions: Careful clinical staging of early, asymptomatic HD patients tr eated with mantle, splenic, and EFRT may obviate the need for exploratory l aparotomy. (C) 2000 Elsevier Science Inc.