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Treatment of early and intermediate stages of supradiaphragmatic Hodgkin's disease: The Swedish National Care Programme Experience |
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| Authors: | Glimelius B; Kalkner M; Enblad G; Gustavsson A; Jakobsson M; Branehog I; Lenner P; for the Swedish Lymphoma Study Group |
| Institution: | 1Departments of Oncology and the Regional Oncological Centres, Uppsala University Akademiska sjukhuset, Uppsala 2Departments of Oncology and the Regional Oncological Centres, Lund University Lund 3Departments of Oncology and the Regional Oncological Centres, Linköping University Linköping 4Departments of Oncology and the Regional Oncological Centres, Gothenburg University Sahlgrenska sjukhuset, Gothenburg 5Departments of Oncology and the Regional Oncological Centres, Umeå University Umeå, Sweden |
| Abstract: | PURPOSE: Since 1985 a Swedish National Care Programme has provided tailoredprinciples for the staging, treatment and follow-up of patientswith Hodgkin's disease (HD). This report presents treatmentresults for all patients below 60 years of age who were diagnosedwith early and intermediate stages, between 1985 and 1989. PATIENTS AND METHODS: During that period, 210 patients with supradiaphragmatic HDin clinical (CS) and pathological (PS) stages IA + IIA, PS IB+ IIB, and PS III1, A were diagnosed in five Health Care Regionsin Sweden. In patients with CS IA, staging laparotomy was notrecommended provided that the radiological assessment of theabdomen was adequate, whereas this procedure was recommendedin stages CS IB, IIA and IIB in order to minimize treatment.In the absence of bulky mediastinal disease, patients with CS+ PS IA and PS IIA were treated with mantle (occasionally mini-mantle)irradiation alone, while patients with bulky disease, as wellas those with stages PS IB + IIB + III1A, were treated withone cycle of MOPP/ABVD prior to mantle (PS III1, A sub-totalnodal) irradiation. Full chemotherapy followed by radiotherapy to initial siteswith bulky disease was recommended for patients with CS IIAwho did not undergo laparotomy. RESULTS: After a median follow-up in excess of five years, treatmentresults are ‘favourable’ for all stages, providedthe recommendations were followed. In patients with CS + PSIA treated according to the recommendations, recurrence rateswere 14% (9/65) with all but one patient (64/65, 98%) remainingin continuous first or second remission. These figures wereworse in patients treated inadequately (9/26 35%] and 22/2685%], respectively). In PS IIA, adequately-treated patientshad a recurrence rate of 13% (7/52) whereas 5/7 (71%) of thosewith bulky disease who received only mantle irradiation developedrecurrences. Similar patterns also emerged in patients withCS IIA, PS IB + IIB and PS III, A. CONCLUSIONS: The tailored principles, which usually entail less staging and/ortreatment than is generally the case, produced favourable resultswhen applied to an entirely un-selected group of patients withearly and intermediate stages of HD. Hodgkin's disease, combined-modality treatment, radiotherapy |
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