Curative radiotherapy in Hodgkin's disease: significance of haematogenous dissemination established by examination of peripheral blood and spleen.

Abstract

Studies of peripheral blood leucocyte concentrates in patients with Hodgkin's disease showed two types of cells believed to be typical for the disease in a number of patients. Involvement of the spleen as diagnosed after splenectomy and histological examination showed a close correlation with the presence of these characteristic cells in the peripheral blood. This is believed to be an argument for haematogenous spread or a multicentric origin of the disease in these cases. The results of attempted curative high-voltage radiotherapy with total node irradiation in 24 patients seem to support this concept. On the basis of the Rye classification of clinical stages the results of radiotherapy are not predictable. Six patients in stage II and seven in stage III were in remission, one in each of stages II and IV, and six in stage III had recurrences of the disease within one year. A division into localized or disseminated forms of the disease based on the investigations of blood and spleen showed all localized cases in remission; of the disseminated cases one reached a remission and all others had recurrences. In three patients the therapy could not be completed. These preliminary treatment results are believed to support the idea of a special role of the spleen in the dissemination of the disease. A new classification of clinical stages in Hodgkin's disease is proposed.