Epidural involvement in Hodgkin's disease

Epidural involvement is analyzed retrospectively in 512 patients with primary treatment and follow up for Hodgkin's disease (HD) between 1970 and 1999. In one case (0.2%) epidural manifestation was the first symptom and in six cases (1.2%) it occurred later, at a disseminated, advanced stage. All seven patients were male: three had mixed cellularity and four nodular sclerosis histological subtype. The thoracic segment was involved in four cases, the lumbar in two and the cervical segment in one case. The most frequent symptoms were back pain, limb weakness, paresis/plegia, incontinence. Computer tomography, magnetic resonance imaging and myelography were used as diagnostic procedures and in planning the treatment. Functional recovery was achieved by laminectomy, loco-regional irradiation and adjuvant polychemotherapy with remission of HD for 6-100 months. Later, however, six patients died due mainly to relapse/progression of HD. We emphasize the importance of an interdisciplinary approach in the treatment of HD with this relatively rare appearance, which requires close co-operation among oncohematologists, neurologists, radiologists, neurosurgeons, radiotherapists and physiotherapists.