Radiotherapy results in laparotomy-staged Hodgkin's disease

Between 1970 and 1978, 131 patients with laparotomy-staged, supradiaphragmatic Hodgkin's disease were treated at the Royal Marsden Hospital with mantle radiotherapy, reserving chemotherapy for relapse. Forty-four patients relapsed at a total of 64 sites, the majority of which were infradiaphragmatic. Analysis of the factors predicting relapse showed that bulky mediastinal disease, and three or more sites of involvement at presentation significantly decreased disease-free survival in this group. Age above 60 years, high erythrocyte sedimentation rate (ESR) and adverse histology were of borderline significance. Although the majority (75%) of relapsed patients were salvaged with subsequent chemotherapy, it is suggested that patients with three or more sites of nodal involvement and bulky mediastinal disease would be managed best with initial combined modality therapy.