Radiotherapy alone for lymphocyte-predominant Hodgkin's disease

Pamela J. Schlembach, Richard B. Wilder, Dan Jones, Chul S. Ha, Luis E. Fayad, Anas Younes, Fredrick Hagemeister, Mark Hess, Fernando Cabanillas, James D. Cox

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Abstract

PURPOSE: The purpose of the study was to analyze the results with radiotherapy alone in a select group of asymptomatic adults with nonbulky, early-stage lymphocyte-predominant Hodgkin's disease. PATIENTS AND METHODS: Between 1963 and 1995, 36 patients with nonbulky stage IA (N = 27) or IIA (N = 9) supradiaphragmatic (N = 27) or subdiaphragmatic (N = 9) lymphocyte-predominant Hodgkin's disease were treated with radiotherapy alone. Eleven of the patients underwent laparotomy. Limited-field radiotherapy involving only one side of the diaphragm and extended-field radiotherapy encompassing both sides of the diaphragm were used in 28 and 8 cases, respectively. Median dose to involved areas was 40.0 Gy given daily in 20 2.0-Gy fractions. Salvage treatment consisted of MOPP (mechlorethamine, vincristine, prednisone, procarbazine), CVPP/ABDIC (cyclophosphamide, vinblastine, procarbazine and prednisone/doxorubicin, bleomycin, dacarbazine, lomustine, and prednisone), or ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy and/or involved-field radiotherapy. RESULTS: Median follow-up was 8.8 years (range, 3.0-34.4 years). None of the 15 patients with supradiaphragmatic disease who received limited-field radiotherapy to regions that did not include the mediastinal or hilar nodes subsequently experienced relapse there. Only one of 20 patients who received supradiaphragmatic limited-field radiotherapy alone experienced relapse in the paraaortic nodes or spleen. The 5-year relapse-free and overall survival rates for the 20 patients with stage IA lymphocyte-predominant Hodgkin's disease treated with involved-field or regional radiotherapy were 95% and 100%, respectively. There were no cases of severe or life-threatening cardiac toxicity. No solid tumors have been observed in-field in patients treated with limited-field radiotherapy, even though they have been followed up longer than those treated with extended-field radiotherapy (median follow-up, 11.6 vs 5.5 years); two solid tumors have developed in-field in patients who received extended-field radiotherapy. DISCUSSION: Involved-field or regional radiotherapy alone may be adequate in stage IA lymphocyte-predominant Hodgkin's disease patients. Longer follow-up will help to more clearly define the risks of cardiac toxicity and solid tumors that result from involved-field or regional radiotherapy, which appear to be low based on follow-up to date.

Original languageEnglish (US)
Pages (from-to)377-383
Number of pages7
JournalCancer Journal
Volume8
Issue number5
DOIs
StatePublished - Oct 1 2002

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Keywords

  • Lymphocyte-predominant Hodgkin's disease
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Schlembach, P. J., Wilder, R. B., Jones, D., Ha, C. S., Fayad, L. E., Younes, A., Hagemeister, F., Hess, M., Cabanillas, F., & Cox, J. D. (2002). Radiotherapy alone for lymphocyte-predominant Hodgkin's disease. Cancer Journal, 8(5), 377-383. https://doi.org/10.1097/00130404-200209000-00008