Stage I-III Hodgkin's Disease: Outcome and Pattern of Failure Following Treatment with Radiation Therapy and Chemotherapy in a Modern Era

Abstract

Purpose: To analyse the long term outcome, pattern of failure and treatment related complications after radiation therapy (RT) with or without chemotherapy for stage I—III Hodgkin's disease (HD).

Material and methods: Detailed records from 86 patients with stage I—III HD treated between 1989 and 1998, were retrospectively reviewed. Seventeen patients with favourable stage I-IIA were treated with RT alone, and the remaining 69 patients with combined modality treatment (CMT). Patients treated with RT received extended-field or subtotal nodal irradiation (STNI) to a total dose of 36–54 Gy, and patients with CMT, received involved-field irradiation to a lower doses, 26–40 Gy. The median follow-up time was 50 months (range 16–180).

Results: The 10-year overall survival (OS) for the whole group was 96% (SE 2%), 100% for stage I, 95% for stage II and 100% for stage III patients. Of potential prognostic factors analysed for statistical significance, only the response to chemotherapy (p = 0.0393) was found to influence significantly OS rates. Twelve patients (13.9%) relapsed. Salvage treatment was effective in 10 of the 12 relapsed patients. The 10-year freedom from treatment failure (FFTF) was 79% (SE 6%). Although 8 (9.6%) of the 83 surviving patients developed late effects that could represent toxicity from the treatment, no patient died of late complications.

Conclusions: RT alone for favourable early stage HD attains good survival rates with a modest treatment related morbidity. For patients with unfavourable stage II and stage III HD, CMT with limited RT provides a good to excellent prognosis.

Keywords:

• Hodgkin's disease
• Radiation therapy
• Combined modality therapy
• Stage I–III
• Combined quemotherapy