Radiotherapy alone in the treatment of clinical stage I-IIA, nonbulky, Hodgkin's disease: Single-institution experience on 73 patients staged with lymphangiography and laparoscopy

Renzo Mazzarotto, Caterina Boso, Giovanni Scarzello, Domenico Rubello, Dario Casara, Savina Aversa, Vanna Chiarion-Sileni, Silvio Monfardini, Guido Sotti

Research output: Contribution to journalArticlepeer-review

Abstract

From 1985 to 1998, at the Regional Cancer Center of Padua, patients with Hodgkin's disease (HD) routinely underwent a clinical staging procedure including lymphangiography and laparoscopy with multiple liver and spleen biopsies. Patients with IA and IIA nonbulky HD were treated with radiotherapy alone. The aim of this study is to analyze the efficacy of radiotherapy as radical treatment in this group of patients, and the role of lymphangiography and laparoscopy in the selection of patients with abdominal disease located to the spleen, liver, or the pelvic lymphatic chains. From January 1985 to January 1998, 94 previously untreated patients with biopsy-proven HD underwent clinical staging procedures consisting of history, physical examination, routine laboratory tests, chest radiography, total-body computed tomography scan, and bone marrow biopsy and were considered in stage I-IIA nonbulky. In addition, all patients underwent bipedal lymphangiography, which was positive in 12 (12.8%). Of the 82 patients with negative lymphangiography, 9 (11%) showed disease below the diaphragm at laparoscopy with multiple random spleen and liver biopsies. Of the remaining 73 patients, 32 were male and 41 were female with a median age of 29 years (range: 14-72 years). The stage at diagnosis was IA in 34 patients and IIA in 39. Histology was nodular sclerosis (NS) in 44 patients, lymphocyte predominance (LP) in 16, and mixed cellularity (MC) in 13. Of the 39 IIA stage patients, 27 showed an involvement of 2 lymph-nodal regions, 11 of 3 regions, and 1 of 4 regions. All patients were treated with radiotherapy alone for a total dose of 39.6 Gy in 22 fractions. Of the 39 IIA stage patients, 36 were treated with subtotal lymphoid irradiation (STLI), mantle plus paraaortic and spleen field, and 3 with mantle field alone, while of the 34 IA stage patients, 20 were treated with STLI, 13 with mantle field, and 1 with involved field. After a medium follow-up of 104 months (minimum 27, maximum 195, median 101), 71 patients (97%) are still alive without evidence of disease. Seven patients (10.4%) relapsed 3, 11, 12, 15, 28, 29, and 48 months after the diagnosis. Initially the stage of these patients was IA in 3 and IIA in 4, whereas the histology was NS in 5, LP in 1, and MC in 1. One patient alone had a pelvic failure, 48 months after the first diagnosis. The other sites of relapse were: bone marrow in 2 patients, bone marrow plus liver in 2, axillary nodes in 1, and internal mammary chain nodes in another. All relapsed patients had previously undergone subtotal lymphoid irradiation (STLI). At relapse, 5 patients received chemotherapy, 1 chemotherapy plus radiotherapy, and 1 radiotherapy alone. Five of 7 patients obtained a second complete remission still lasting after 27, 68, 70, 98, 103 months, respectively, whereas 2 patients (2.9%) died of progressive disease, respectively, 3 and 35 months after relapse. Our data suggest that a well-defined group of patients with early stage HD, who undergo an accurate clinical staging procedure, can be effectively treated with radiotherapy alone.

Original languageEnglish
Pages (from-to)149-152
Number of pages4
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume25
Issue number2
DOIs
Publication statusPublished - 2002

Keywords

  • Clinical staging
  • Hodgkin's disease
  • Laparoscopy
  • Lymphangiography
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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