Sternberg's lymphoma: effect of treatment regimen upon prognosis in 38 cases

Thirty-eight cases of diffuse poorly differentiated lymphoma with an anterior mediastinal mass were reviewed. Nine patients had stage I disease, 11 stage II, one stage III and 17 stage IV. Survival was prolonged in those stage III and IV cases whose treatment had commenced with chemotherapy rather than with radiotherapy. Survival and relapse-free interval were prolonged in all cases when chemotherapy had begun within a week of diagnosis and had continued with intervals of not more than 21 d between courses. Although patients whose chemotherapy had been delayed while radiotherapy was given fared worse overall, the incidence of mediastinal relapse was significantly increased when mediastinal irradiation had been omitted altogether or had been given in fractions of less than 100 rads. Prophylactic cranial irradiation and intrathecal chemotherapy reduced the incidence of CNS involvement in all stages of the disease. Testicular involvement occurred in three patients, two of them detected only at post-mortem, and occult ovarian involvement was also found in two post-mortems. Therapeutic principles are proposed including immediate systemic chemotherapy followed by mediastinal irradiation and CNS prophylaxis as soon as practicable after chemotherapy is begun and, later, testicular biopsy, or CT scan or ultrasound assessment of pelvic organs.