Results of a prospective trial of mantle irradiation alone for selected patients with early-stage Hodgkins's disease

Purpose: To determine the efficacy of mantle radiation therapy alone in sel ected patients with early-stage Hodgkin's disease. Patients and Methods: Between October 1988 and June 2000, 87 selected patie nts with pathologic stage (PS) IA to IIA or clinical stage (CS) IA Hodgkin' s disease were entered onto a single-arm prospective trial of treatment wit h mantle irradiation alone. Eighty-three of 87 patients had greater than or equal to 1 year of follow-up after completion of mantle irradiation and we re included for analysis in this study. Thirty-seven patients had PS IA, 40 had PS IIA, and six had CS IA disease. Histologic distribution was as foll ows: nodular sclerosis (n = 64), lymphocyte predominant (n = 15), mixed cel lularity (n = 3), and unclassified (n = 1). Median follow-up time was 61 mo nths. Results: The 5-year actuarial rates of freedom from treatment failure (FFTF ) and overall survival were 86% and 100%, respectively. Eleven of 83 patien ts relapsed at a median time of 27 months. Nine of the 1 1 relapses contain ed at least a component below the diaphragm. All 11 patients who developed recurrent disease were alive without evidence of Hodgkin's disease at the t ime of last follow-up. The 5-year FFTF in the 43 stage I patients was 92% c ompared with 78% in the 40 stage II patients (P = .04). Significant differe nces in FFTF were not seen by histology (P = .26) or by European Organisati on for Research and Treatment of Cancer I-I-SE eligibility (P = .25). Conclusion: Mantle irradiation alone in Selected patients with early-stage Hodgkin's disease is associated with disease control rates comparable to th ose seen with extended field irradiation. The FFTF is especially favorable among stage I patients. (C) 2001 by American Society of Clinical Oncology.