Anatomic substages of stage IIIA Hodgkin's disease: followup of a collaborative study

The clinical significance of anatomic substage was reassessed in a previously reported series of 130 patients with Hodgkin's disease in pathologic stage IIIA. For 100 patients, followup was greater than 8 years. By definition, stage III1 disease includes involvement of spleen or splenic, celiac, or portal nodes, or any combination of these; stage III2 disease includes involvement of para-aortic, iliac, or mesenteric nodes, with or without upper abdominal involvement. Both 8-year relapse-free survival (71% versus 40%) and 8-year overall survival (80% versus 54%) were better in stage III1A than in III2A patients (P less than 0.001). For stage III1A, relapse-free survival was better in patients receiving radiotherapy alone as initial treatment (92% versus 60%, P less than 0.002). However, 8 year overall survival rates in these two treatment groups were not significantly different (88% versus 76%, P = 0.20). For stage III2A, both relapse-free survival at 8 years (84% versus 19%, P less than 0.001) and overall survival at 8 years (84% versus 41%, P less than 0.01) were superior in patients receiving combined modality therapy. Anatomic substage is a critical prognostic variable, especially if standard total nodal radiotherapy is considered as one of the therapeutic options.