Anatomical substages of stage III Hodgkin's disease.Implications for staging, therapy, and experimental design

Abstract

Twenty-three patients with pathologic stage III Hodgkin's disease were classified with respect to the presence or absence of symptoms (III-A, III-B), the presence or absence of splenic involvement (IIIS+, IIIS-) and anatomic substage—the extent of disease within the abdomen (III₁, III₂). Stage III₁ disease included disease limited to the upper abdomen, i.e., spleen, splenic node, celiac node, and/or portal node. All other more extensive disease was classified as stage III₂. Symptoms and splenic involvement did not predict either disease-free survival or survival. However, 5 year actuarial disease-free survival was significantly better in III₁ patients as compared to III² patients (77% vs. 13%, p < 0.001). Eight of nine stage III² patients receiving total nodal radiotherapy alone relapsed. When considered along the previous studies of anatomic substage, these findings suggest that patients in stage III₁ and III₂ should receive different therapeutic approaches. Analysis of therapeutic results in stage III patients must consider anatomic substage.