Treatment of patients with “minimal” stage IIIA hodgkin's disease

Abstract

Treatment recommendations for patients with upper abdominal Stage IIIA Hodgkin's (III 1A) disease have varied widely. The current study reports on a combined institutional retrospective review of 85 patients with surgically staged III 1A Hodgkin's disease. Twenty-two patients received combined modality therapy (CMT), 36 patients were treated initially with total nodal irradiation (TNI), and 27 with mantle and para-aortic radiotherapy (MPA). Patients treated with CMT had an actuarial 8-year freedom from relapse (FFR) of 96% as compared to a FFR of 51% in TNI treated patients ( p = 0.002), and a FFR of 54% in MPA treated patients ( p = 0.004). Of the 11 relapses in MPA treated patients, 7 had a component of their failure in the untreated pelvic or inguinal nodes. The patients treated with CMT had an 8-year actuarial survival of 100% as compared to 79% in TNI treated patients ( p = 0.055) and 78% in patients treated with MPA ( p = 0.025). Histology and the number of splenic nodules were the most important prognostic variables. Patients with MC/LD histology and ≥5 splenic nodules have a high risk of relapse ( 10 13 ) when treated with radiation alone (TNI or MPA). We recommend CMT for this group of patients. Patients with NS/LP histology and 1–4 splenic nodules represent a favorable subset of Stage III 1A patients. Only 4 21 patients have relapsed and all 21 patients are currently alive without disease regardless of treatment. We currently feel that patients with Stage III 1IA Hodgkin's disease with NS/LP histology and splenic disease limited to 1–4 nodules are good candidates for MPA as an alternative to TNI or CMT.