ABSTRACT
Two hundred and fifty-five patients with Hodgkin's disease and with localized pulmonary involvement (Stage IIE) were retrospectively assessed for their response to different treatment programmes while considering the size of mediastinal lymph nodes and the extent of pulmonary disease (involvement of lung subsegment, segment or lobe). Five-year overall and disease-free survival rates in 255 patients were 89.6% and 72.3%, respectively. In patients with mediastinal index < 1/3 and lung segment and/or subsegment involvement, 5-year overall and disease-free survival rates were 96.6%. For patients with mediastinal index > 1/3 and similar lung involvement the corresponding values were, respectively, 88.6% and 73.5%; and for those with a lung lobe involvement the values were 76.4% and 56.7%, respectively. Patients were treated according to the following programmes: 1 combination chemotherapy cycle + radiotherapy (RT) + 4-5 combination chemotherapy cycles; 3 combination chemotherapy cycles + RT; 6 combination chemotherapy cycles + RT. The best results were obtained with the programme consisting of 1 combination chemotherapy cycle + lymphoid irradiation above the diaphragm and irradiation of the spleen to a total tumour dose of 40 Gy and irradiation of involved lung sites to a total tumour dose of 20 Gy + 4-5 combination chemotherapy cycles.
Subject(s)
Hodgkin Disease/therapy , Lung Neoplasms/secondary , Mediastinal Neoplasms/secondary , Combined Modality Therapy , Hodgkin Disease/mortality , Hodgkin Disease/pathology , Humans , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Lymphatic Metastasis , Mediastinal Neoplasms/pathology , Mediastinal Neoplasms/therapy , Survival RateABSTRACT
This study presents the analysis of results obtained in 237 Hodgkin's disease patients, stages I and II, treated with combined modality therapy. The overall and disease-free survival rates at 5 years were 96.6 and 85.2%, respectively. The study has demonstrated the superiority of the following treatment program: one cycle of combination chemotherapy + radiation therapy + 5 cycles of combination chemotherapy. It has been found possible to reduce the number of radiation fields in combined modality therapy: for patients with stage IA-IIA lymphocyte predominant or nodular sclerosing Hodgkin's disease it was sufficient only to treat clinically involved sites. Short- and long-term consequences of combined modality therapy have been analysed.
