Significance of epitrochlear lymph node involvement in Hodgkin disease

BACKGROUND. Epitrochlear involvement in Hodgkin disease (HD) is a rare even t, with only limited data available describing this unique presentation, it s treatment, and long term outcome. METHODS. Between 1968 and 1997, 1180 patients with clinical stage (CS) IA-I IB HD were treated at the Harvard Longwood Area Hospitals, among whom 11 we re identified to have presented with epitrochlear lymphadenopathy (1%). Tog ether with 6 CS III-IV patients also with clinically involved epitrochlear lymph nodes at diagnosis, these 17 patients form the basis of the current s tudy. The clinical characteristics, histopathologic distribution, and treat ment details are described. Two radiation therapy techniques were used: the "single field" and "separate-field" techniques. The median dose to the epi trochlear region was 3600 centigrays. Survival outcome was calculated by th e Kaplan-Meier method. The median followup was 17 years. RESULTS. The actuarial 15-year freedom from recurrence, cause specific surv ival, and overall survival (OS) rates for the 17 patients were 70%, 88%, an d 70%, respectively. Among the CS IA-IIB patients, the 15-year OS rates of the 1169 patients and II patients without and with epitrochlear involvement were 80% and 90%, respectively. Two of the 11 CS IPI-IIB and 3 of the 6 CS III-TV patients experienced recurrence. None of the recurrences involved t he epitrochlear or ipsilateral brachial region regardless of the treatment technique, and no complications from the local radiation therapy were obser ved. CONCLUSIONS, Feasible and effective radiation therapy techniques are availa ble for patients with HD with epitrochlear involvement. If appropriately tr eated, the prognosis of patients with this unique presentation appears to b e similar to that of other HD patients. (C) 2001 American Cancer Society.