Stage IA to IIB supradiaphragmatic Hodgkin's disease. Long-term survival and relapse frequency

Long-term survival and prognostic factors were analyzed in 307 patients with pathologically staged IA to IIB supradiaphragmatic Hodgkin's disease (HD). Treatment with radiation therapy (RT) alone resulted in a 10-year actuarial freedom from first relapse (FFR) of 88% and 10-year survival of 95% for Stage IA patients and a FFR and survival of 76% and 93%, respectively, for Stage IIA patients. Stage IB to IIB patients had similar survivals when treated with combined-modality therapy (CMT) (85%) or RT alone (77%). Stage IA to IIB patients with large mediastinal adenopathy (LMA) treated with RT alone had a significantly worse survival as compared with patients with lesser or no mediastinal adenopathy, 83% versus 94%, respectively, P = 0.006. Initial CMT for patients with LMA resulted in an improved FFR as compared with patients treated with RT alone, 83% versus 49%, respectively (P = 0.05); however, no differences in survival were seen. Other prognostic factors are analyzed. These data support the initial use of Rt alone in early-stage Hodgkin's disease patients. CMT should only be used for selective patients, such as those with LMA in which the volume to be irradiated is large. In these patients, initial chemotherapy followed by irradiation may allow treatment of small volumes of heart and lung.