Hodgkin's lymphoma in adults--clinical features

One hundred (100) patients were treated in the Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, from 1980-1994. All patients were evaluated and staged according to the accepted guidelines at the treatment times. All patients were followed on a strict follow-up schedule for the outcome of treatment including late effects. The age range was 18 years-77 years. The age groupings are described in Table 1. Eighty-one percent (81%) of the patients were 40 years of age or younger. Nineteen percent (19%) of the patients were older and this was similar to the reported bimodal pattern in Hodgkin's disease. Fifty-eight percent (58%) of the patients were female and the rest were male. Eighty-eight percent (88%) of the patients were Caucasian as depicted in Table 2. Majority of the patients (64) presented with mass in the neck. Some of the patients presented with one or more symptoms and signs. The details of the presentation features are shown in Table 3. Thirty-one percent (31%) of the patients presented with one or more of the 'B' symptoms as described by Cotswolds Staging Classification for Hodgkin's Disease. These include fever (temperature >38 degrees C), drenching night sweats, and unexplained loss of >10% body weight within the preceding 6 months. Appropriate staging included complete physical examination, blood studies, and imaging studies such as plain chest x-rays, lymphangiograms, CT scans, gallium scans, etc. Forty-eight percent (48%) of the patients had staging laparotomy with lymph node sampling, splenectomy, and liver biopsies. The staging was done according to Ann Arbor Staging Classification. Forty-four percent (44%) of the patients were in Stage IIA group and the rest are shown in Table 4. Of the sites of involvement, neck (82 patients) and mediastinum (79 patients) were the common sites. Other sites of involvement are described in Table 5. Many patients had more than one site of involvement. Thirty-three percent (33%) of the patients had bulky mediastinal disease. This was defined based on the ratio of the width of the lesion to the transverse diameter of the chest. The most common histological subtype was nodular sclerosing (73%). This would explain the gender variation in this group of patients. The histological classification was done according to the Rye Classification (Table 6).