Irradiation therapy in Hodgkin's disease.

Abstract

The study of Hodgkin's disease includes many interesting pathologic and clinical ramifications. One of the most consistent observations in this disease has been that, although the lesions appear radiosensitive, the mortality rate is high. Previous reports from this institution (34, 35) have outlined the general therapeutic approach and given the survival figures obtained in the past. It is the present purpose to bring up to date the results of irradiation therapy in Hodgkin's disease at the University of Minnesota Hospitals and to review fundamental concepts on the nature of this disease and its therapeutic management. Historical Data Historical reviews of Hodgkin's disease can be found in numerous publications and here will be limited largely to references (2, 16, 17, 18, 22, 26, 32, 38, 40, 49–53, 55, 56). A particularly accurate histologic description of the characteristic cells was given by Reed (40), in 1902. Many suggestions as to the cause of Hodgkin's disease have been made, but none has been substantiated. The absence of any proved infectious agent, the high fatality rate, and the occurrence of cases with apparent primary lesions and later metastases tend to support the neoplastic theory. Clinical Picture The clinical picture in Hodgkin's disease is variable. Enlargement of single or multiple groups of lymph nodes may be the only complaint. Onset may be heralded by weakness, fever, anorexia, nausea and vomiting, weight loss, or pruritus. Cough, dyspnea, cyanosis, or dysphagia may be indicative of mediastinal lymphadenopathy. Pulmonary parenchymal involvement may be accompanied by fever and the lesions may cavitate. Frequent coincident infections include tonsillitis, upper respiratory, otitic, and oral infections. Vertebral or extradural involvement may produce monoplegia or paraplegia. Backache is commonly caused by enlarged retroperitoneal nodes. Localized pain usually precedes actual roentgen demonstration of bone lesions, and bone marrow studies may disclose multiple granulomas. Jaundice may be due to enlarged nodes about the common duct or to actual hepatic involvement. Enlargement of the spleen, invasion of the stomach and kidneys, as well as involvement of other organs, may be accompanied by clinical findings. Specific skin lesions are not infrequently demonstrated, and herpes zoster occurs in some cases. Pathology Pathologically (2), the lymph nodes grossly are enlarged, pale, and firm, discrete, and of fleshy or fibrous consistency. They are not easily differentiated from other lymph node tumors.