The Analyses of Treatment Results and Prognostic Factors in Supradiaphragmatic CS I-II Hodgkin's Disease

Park, Won; Suh, Chang Ok; Chung, Eun Ji; Cho, Jae Ho; Kim, Joo Hang; Chung, Hyun Cheol; Roh, Jae Kyung; Hahn, Jee Sook; Kim, Gwi Eon

Abstract

PURPOSE: The aim of this retrospective study is to assess the necessity of staging laparotomy in the management of supradiaphragmatic CS I-II Hodgkin's disease. Prognostic factors and the usefulness of prognostic factor groups were also analyzed.
MATERIALS AND METHODS
From 1985 to 1995, fifty one patients who were diagnosed as supradiaphragmatic CS I-II Hodgkin's disease at Yonsei Cancer Center in Seoul, Korea were enrolled in this study. Age range was 4 to 67 with median age of 30. The number of patients with each CS IA, IIA, and IIB were 16, 25, and 10, respectively. Radiotherapy (RT) was delivered using 4 or 6 MV photon beam to a total dose of 19.5 to 55.6Gy (median dose : 45Gy) with a 1.5 to 1.8Gy per fraction. Chemotherapy (CT) was given in 2-12 cycles (median : 6 cycles). Thirty one patients were treated with RT alone, 4 patients with CT alone and 16 patients with combined chemoradiotherapy. RT volumes varied from involved fields (3), subtotal nodal fields (18) or mantle fields (26).
RESULTS
Five-year disease-free survival rate (DFS) was 78.0% and overall survival rate (OS) was 87.6%. Fifty patients achieved a complete remission after initial treatment and 8 patients were relapsed. Salvage therapy was given to 7 patients, 1 with RT alone, 4 with CT alone, 2 with RT+CT. Only two patients were successfully salvaged. Feminine gender and large mediastinal adenopathy were significant adverse prognostic factors in the univariate analysis for DFS. The significant adverse prognostic factors of OS were B symptom and clinical stage. When patients were analyzed according to European Organization for Research and Treatment of Cancer (EORTC) prog-nostic factor groups, the DFS in patients with very favorable, favorable and unfavorable group was 100, 100 and 55.8% (p<0.05), and the OS in each patients' group was 100, 100 and 75.1% (p<0.05), respectively. In very favorable and favorable groups, the DFS and OS were all 100% by RT alone, but in unfavorable group, RT with CT had a lesser relapse rate than RT alone. The subtotal nodal irradiation had better DFS than mantle RT in patients treated with RT.
CONCLUSION
In present study, the DFS and OS in patients who did not undergo staging laparotomy were similar with the results in the literatures of which patients were surgically staged. Therefore, we may suggest that staging laparotomy would not influence the outcome of treatments. In univariate analysis, gender, large mediastinal adenopathy, B symptoms and clinical stage were significant prognostic factors for the survival rate. We confirm the usefulness of EORTC prognostic factor groups which may be a good indicator to select the treatment modality.