Patterns of relapse in stages I, II and IIIA Hodgkin's disease: Influence of initial therapy and implications for the future

Abstract

An analysis was undertaken of the patterns of relapse observed among 111 patients with Stages I–IIIA Hodgkin's disease. All had undergone staging laparotomy and then received either extended field irradiation alone (60%) or limited field irradiation followed by MOPP (nitrogen mustard, vincristine, procarbazine and prednisone) chemotherapy. A total of 26 relapses occurred; relapse rates after irradiation alone were 34% but only 7% following irradiation plus adjuvant chemotherapy. The duration of both remission and survival was significantly longer for the patients receiving irradiation plus chemotherapy than for those treated with irradiation alone ( p = < 0.001, <0.05, respectively). Survival differences in this study should be considered preliminary, however, until several more years of patient follow-up accrues. For patients with “E” stage disease, remission duration and survival were significantly impaired after irradiation alone; this poor prognosis was not observed after therapy with irradiation plus MOPP. The most common sites of relapse for all patients were marginal recurrences (54%) within mediastinal nodes or adjacent lung parenchyma. Extranodal extension to the lung and large mediastinal masses were significant predisposing factors; 86% of these relapses followed therapy with irradiation alone. Among Stage IIIA patients treated with irradiation alone, abdominal lymph node involvement was associated with more relapses (50%) than if disease was confined to spleen and splenic hilar lymph nodes (17%). No relapses occurred in Stage IIIA disease after adjuvant chemotherapy. Certain patterns of clinical presentation appear most likely to benefit from combined modality therapy. These include “E” stage disease of the lung, large mediastinal masses and Stage IIIA patients with involvement of abdominal lymph nodes.