BACKGROUND: Short course chemotherapy followed by radiotherapy is a standard treatment for early Hodgkin's disease. There is yet no consensus regarding the appropriate radiotherapy portal following chemotherapy. A good guide to the adjuvant radiotherapy field is the site of relapse in patients treated with chemotherapy alone. PATIENTS AND METHODS: From 1980 to 1996, 61 patients with stage I and II supradiaphragmatic Hodgkin's disease were treated with chemotherapy alone at the Royal Marsden Hospital. We undertook a retrospective review and failure analysis to define the pattern of recurrence. RESULTS: After a median follow-up of 6.5 years, 24 patients had relapsed giving a 5-year relapse rate of 40%. The 5 and 10-year actuarial survival rates were 94 and 89%, respectively with cause-specific survival being 94% at 5 and 10 years. Two-thirds of the relapses were nodal and supradiaphragmatic. Twenty patients (83%) relapsed in the initially involved sites of disease and this was the sole site of recurrence in 11 (45%) of patients. In retrospect, it appeared that at least 12 recurrences could have been prevented by involved field radiotherapy. Review of detailed imaging data (available in 9 out of 11 patients with recurrences in initial sites of disease) showed that the relapses were always in the initially involved nodes. CONCLUSION: After chemotherapy alone in early stage HD most initial recurrences are nodal. Loco-regional recurrences are in the originally involved nodes. Based on limited data it appears that involved nodal RT is equivalent to involved field radiotherapy and may halve the risk of recurrence.
BACKGROUND: Short course chemotherapy followed by radiotherapy is a standard treatment for early Hodgkin's disease. There is yet no consensus regarding the appropriate radiotherapy portal following chemotherapy. A good guide to the adjuvant radiotherapy field is the site of relapse in patients treated with chemotherapy alone. PATIENTS AND METHODS: From 1980 to 1996, 61 patients with stage I and II supradiaphragmatic Hodgkin's disease were treated with chemotherapy alone at the Royal Marsden Hospital. We undertook a retrospective review and failure analysis to define the pattern of recurrence. RESULTS: After a median follow-up of 6.5 years, 24 patients had relapsed giving a 5-year relapse rate of 40%. The 5 and 10-year actuarial survival rates were 94 and 89%, respectively with cause-specific survival being 94% at 5 and 10 years. Two-thirds of the relapses were nodal and supradiaphragmatic. Twenty patients (83%) relapsed in the initially involved sites of disease and this was the sole site of recurrence in 11 (45%) of patients. In retrospect, it appeared that at least 12 recurrences could have been prevented by involved field radiotherapy. Review of detailed imaging data (available in 9 out of 11 patients with recurrences in initial sites of disease) showed that the relapses were always in the initially involved nodes. CONCLUSION: After chemotherapy alone in early stage HD most initial recurrences are nodal. Loco-regional recurrences are in the originally involved nodes. Based on limited data it appears that involved nodal RT is equivalent to involved field radiotherapy and may halve the risk of recurrence.
Authors: Kavita V Dharmarajan; Debra L Friedman; Cindy L Schwartz; Lu Chen; T J FitzGerald; Kathleen M McCarten; Sandy K Kessel; Matt Iandoli; Louis S Constine; Suzanne L Wolden Journal: Int J Radiat Oncol Biol Phys Date: 2014-12-24 Impact factor: 7.038
Authors: Frank Lohr; Dietmar Georg; Luca Cozzi; Hans Theodor Eich; Damien C Weber; Julia Koeck; Barbara Knäusl; Karin Dieckmann; Yasser Abo-Madyan; Christian Fiandra; Rolf-Peter Mueller; Andreas Engert; Umberto Ricardi Journal: Strahlenther Onkol Date: 2014-09-11 Impact factor: 3.621
Authors: Chelsea C Pinnix; Andrew Wirth; Sarah A Milgrom; Therese Y Andraos; Michalis Aristophanous; Mary Pham; Donald Hancock; Ethan B Ludmir; Jillian R Gunther; Michelle A Fanale; Yasuhiro Oki; Loretta Nastoupil; Hubert H Chuang; N George Mikhaeel; Bouthaina S Dabaja Journal: Leuk Lymphoma Date: 2018-04-04
Authors: Nick Figura; Stella Flampouri; Nancy P Mendenhall; Christopher G Morris; Barry McCook; Savas Ozdemir; William Slayton; Eric Sandler; Bradford S Hoppe Journal: Adv Radiat Oncol Date: 2017-01-18