PATHOLOGIC STAGES-IA AND STAGE-IIA HODGKINS-DISEASE - RESULTS OF TREATMENT WITH RADIOTHERAPY ALONE (1968-1980)

Between Jan. 1, 1968-Dec. 31, 1980, 108 previously untreated patients with Hodgkin''s disease pathologic stages (PSs) IA (29 patients) and IIA (79 patients) initially received radiotherapy alone. One postoperative death (due to pulmonary embolus) (0.9%) occurred, with 1 serious complication (0.9%). Between 1968-1973, patients were randomized to receive either involved field radiation treatment (RTIF) or extended field radiation treatment (RTEF). Since 1973 all patients have received RTEF, 4,000 cGY [centrigrays] in 4-5 wk, with a median follow-up of 7.4 yr. Complete remission (CR) was achieved in 102 patients (94.4%), with no significant difference according to treatment or stage. Of the complete responders, 25 patients relapsed: 5/15 RTIF and 20/87 RTEF (P = 0.6). Twenty-one of 25 relapsing patients achieved a 2nd CR. Disease free survival rates at 5 and 10 yr constituted: PS IA, 78.6% for both; PS IIA, 74.8% and 73.1% (P = 0.6); RTEF, 76.7% for both; RTIF, 73.3% and 66.7% (P = 0.7). Eighteen patients have died: 8 of recurrent lymphoma, 2 of pulmonary embolus, 1 each of myocardial infarction, pulmonary fibrosis and acute non-lymphocytic leukemia (ANLL) (following salvage chemotherapy) and 1 of diffuse histiocytic lymphoma (DHL). Four patients died in remission of unrelated causes. Actuarial survival rates at 5 and 10 yr constituted: PS IA, 95.7% and 72.4%; PS IIA, 89.6% and 81.4% (P = 0.3); RTIF, 93.7% for both; RTEF, 90.7% and 71.2% (P = 0.2). Age, sex, number of sites and mediastinal involvement did not influence the outcome. Acute toxicity was modest and more frequent among those receiving RTEF (P = 0.08). Chronic toxicity (onset > 30 days after completion of treatment) was identified in 16 patients: 1/16 RTIF; 15/92 RTEF (P = 0.5). Three patients developed to 2nd malignancy: 1 carcinoma of the cervix in situ; 1 ANLL (following salvage chemotherapy); and 1 DHL of the stomach. At least 75% of patients with PS IA and IIA Hodgkin''s disease were cured by radiation alone, with a risk of secondary malignancy following radiation alone of 0.9%. Since the majority of relapsing patients were successfully salvaged by chemotherapy, radiation alone appears to be the initial treatment of choice in this group of patients.