Salvage of relapse of patients with Hodgkin's disease in clinical stages I or II who were staged with laparotomy and initially treated with radiotherapy alone. A report from the international database on Hodgkin's disease.

PURPOSE: To analyze presentation variables that might indicate a high or low likelihood of success of the treatment of patients relapsing after initial radiotherapy of Hodgkin's disease in clinical Stages I or II who were staged with laparotomy. METHODS AND MATERIALS: Data were analyzed on 681 patients in the International Database on Hodgkin's Disease who were initially in clinical Stages I or II, who were staged with laparotomy, and who relapsed after initial treatment with irradiation alone. Factors analyzed for outcome after first relapse included initial stage, age, sex, histology, presentation (supra- vs. infradiaphragmatic), number of involved areas, mediastinal involvement, E-lesions, B-symptoms, erythrocyte sedimentation rate, lactate dehydrogenase, alkaline phosphatase, serum albumin, and hemoglobin.
RESULTS: Only age and histology showed significant prognostic impact in univariate and multivariate analyses. The influence of age may perhaps be attributed to suboptimal treatment of some older patients. Patients with nodal relapse had a better prognosis than patients with extranodal relapse, probably indicating that the latter had more extensive disease at relapse. The length of the initial disease-free interval had no influence on prognosis after relapse.
CONCLUSION: The decisive factors for outcome after initial treatment with irradiation alone are a) the factors predicting the risk of relapse after initial radiotherapy and b) the factors predicting outcome after relapse, that is, histologic subtype and extent of disease at relapse.