Abstract
The patterns of early and late relapses (those occurring later than 3 years after diagnosis) in 432 patients achieving complete remission after treatment for stage I and II Hodgkin's disease at the Royal Marsden Hospital between 1964 and 1983 were studied to identify factors predicting for late relapse. The incidence of early relapse has fallen progressively in recent treatment eras as staging procedures and management have improved but in contrast there has been no decrease in the risk of late relapse. The incidence of late relapse was greater in patients treated with radiotherapy rather than combined modality therapy (P less than 0.05). However, patients who were clinically staged and treated with combined modality therapy retained as high a risk of relapse between 3 and 6 years as in years 2 and 3. The risk of late relapse was also greater in patients with stage II disease and in those without B symptoms at presentation. Patients falling into the higher risk categories for late relapse require continued close follow-up beyond 3 years to monitor for possible relapse.
Highlights
We have undertaken a study of all adult patients with early stage Hodgkin's disease treated at the Royal Marsden Hospital between 1964 and 1983 to analyse the timing of relapse with changing management strategies and to identify factors predicting for late relapse which might determine the need for long-term follow-up
A total of 447 adult patients received their primary treatment for stage I or II Hodgkin's disease at the Royal Marsden Hospital between 1964 and 1983; the 432 patients achieving complete remission were selected for study
Through successive treatment eras the percentage of patients suffering early relapse has fallen progressively, being 42.3% in 1964-69, 27.9% in 1970-74, 17.4% in 1975-80 and 8.9% in 1980-83
Summary
A total of 447 adult patients received their primary treatment for stage I or II Hodgkin's disease at the Royal Marsden Hospital between 1964 and 1983; the 432 patients achieving complete remission were selected for study. As improved staging techniques and treatments were developed management policies changed. Between 1964 and 1969 patients were staged clinically and the majority received radiotherapy alone, with a few having additional single-agent chemotherapy (cyclophosphamide or mustine). Between 1970 and 1974 staging laparotomies were introduced but the majority of patients continued to receive radiotherapy alone. From 1980 onwards the use of staging laparotomies declined as the factors predictive of occult infradiaphragmatic disease were identified (Brada et al, 1986): the poor-risk patients were treated electively with combined modality therapy. Received 22 September 1988, and in revised form, 6 February 1989
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