The impact of pelvic recurrence and elective pelvic irradiation on survival and treatment morbidity in early-stage hodgkin's disease

Abstract

A retrospective analysis of patients with supradiaphragmatic Stage I–II Hodgkin's disease was performed to assess the impact of pelvic recurrence and elective pelvic irradiation on survival and treatment morbidity. One hundred twenty patients were treated with radiotherapy (RT) alone; 38 received total nodal (including pelvic) irradiation (TNI), 63 received modified total nodal (excluding pelvic) irradiation (MTNI), and 19 received involved-field or mantle irradiation only (<MTNI). Thirty-three patients received combined-modality therapy. In laparotomy-staged (PS) patients treated with RT alone, the overall treatment failure rate was 13% after TNI, 24% after MTNI, and 43% after <MTNI. The pelvic failure rate in PS patients was 0% after TNI, 9% after MTNI, and 29% after <MTNI. Cause-specific deaths in patients treated with RT alone occurred in 10% following <MTNI, 13% following MTNI, and 10% following TNI. Cause-specific deaths due to pelvic failure in patients treated with RT alone occurred in 5% following IF and 6% following MTNI, and also occurred in 7% of patients receiving combined-modality therapy. The potential disadvantages of elective pelvic irradiation in early-stage Hodgkin's disease include compromise of future tolerance of chemotherapy in the event of treatment failure, and infertility. Gonadal function was assessed in 67 patients <35 years old at the time of treatment. Compromise of gonadal function was correlated with the lack of special testicular shielding during pelvic irradiation and chemotherapy in the male, and with no oophoropexy before pelvic irradiation in the female. Twelve of 26 patients with recurrence after either <MTNI or MTNI, with or without chemotherapy, were alive and without evidence of disease at >2 years after completing salvage therapy, compared with 7 of 11 patients with recurrence after TNI.