Treatment outcome in patients younger than 60 years with advanced stages (IIB-IV) of Hodgkin's disease: the Swedish National Health Care Programme experience

Background - Despite improved treatment results achieved in Hodgkin's disea se (HD), only about 70% of patients with advanced stages are cured. The pri mary aim of this study was to evaluate the outcome of advanced stages (IIB- IVB) of HD in younger patients in an unselected population-based group of p atients. The patients were recommended individualized treatment with respec t to number of chemotherapy (CT) courses and post-CT radiotherapy (RT) base d on pretreatment characteristics and tumour response. Secondly, we investi gated if variables of prognostic importance could be detected. Patients and methods - Between 1985-92, 307 patients between 17-59 yr of age (median 36 ) were diagnosed with HD in stages IIB-IVB in 5/6 health care regions in Sw eden. Median follow-up time was 7.8 yr (1.3-13). Retrospectively, laborator y parameters were collected. Results - In total, 267 (87%) patients had a c omplete response (CR). The overall and disease-free 10-yr survivals in the whole cohort were 76% and 67%, respectively. There was no difference in sur vival between the groups of patients who received 6 or 8 cycles of CT. Surv ival was not higher for patients in CR after CT when RT was added. For thos e in PR after CT, additional RT raised the frequencies of CR. A selected gr oup of pathologically staged patients was successfully treated with a short course (2 cycles) of CT + RT. In univariate analyses survival was affected by age, stage IVB, bone-marrow involvement, B-symptoms, S-LDH, S-Alb and r eaching CR or not after 2, 4 and 6 cycles of CT. In a multivariate analysis , age and reaching CR after 6 cycles of CT remained statistically significa nt. Conclusions - The lack of difference in survival between the groups of patients who received 6 versus 8 cycles of CT indicates a successful select ion of patients for the shorter treatment. Reaching a rapid CR significantl y affected outcome. Whether some patients need less CT than the generally r ecommended 8 courses can properly only be evaluated in a randomised study. Additional RT may play a role in successful outcome, particularly if residu al tumours are present, but its precise role call also only be defined in p rospectively randomised studies. Reaching CR after CT was the most importan t variable affecting survival besides age.