Radiotherapy results for nodular sclerosing Hodgkin's disease after clinical staging

Abstract

Certain features of nodular sclerosing Hodgkin's disease predispose toward achievement of excellent radiotherapeutic results using clinical staging rather than currently advocated surgical staging including laparotomy. These include a distinct pattern of contiguous lymphatic involvement and the infrequent dissemination of disease to extranodal sites in early stage patients. Only three of 58 consecutive Clinical Stage I-III patients initially treated with radiotherapy alone between 1965 and 1969 have died from Hodgkin's disease. The 10-year survival rates corrected for intercurrent deaths are 97%, 90%, and 86% for Stages I-IIA, IIB, and III respectively. The usual prognostic influence of “B” symptoms was not evident following extended prophylactic irradiation. Likewise, there was no discernible influence of the subtype (lymphocyte predominant, mixed cellularity, lymphocyte depletion) on survival with these nodular sclerosis patients. There was a single extension of disease to iliac nodes in 46 patients with supradiaphragmatic involvement for whom prophylactic irradiation did not extend below the aortic bifurcation, providing justification for modified total nodal irradiation. Development of extranodal dissemination was observed in only 4/58(7%) patients, indicating that adjuvant chemotherapy is not warranted or justified in the early stages of nodular sclerosing Hodgkin's disease.