[A retrospective analysis of the treatment results in Hodgkin's disease in a radiotherapy clinic]

Abstract

Purpose: Treatment results were reviewed in a retrospective analysis and compared with literature data. Prognostic factors for freedom from relapse and overall survival were identified.

Patients and methods: We analyzed the history of 183 patients treated for Hodgkin's disease between 1977 and 1989 at the Department of Radiation Therapy at the University of Würzburg. There were 100 males and 83 females between 16 and 86 years of age. 70.5% of patients presented with early stage Hodgkin's disease (23.5% stage I and 47.0% stage II) and 29.5% had advanced stages (25.1% stage III and 4.4% stage IV). All patients were treated initially with radiotherapy, 114 had radiotherapy alone and 69 patients received combined modality treatment.

Results: Hundred and sixty-one patients (88.0%) reached a complete remission. Freedom from relapse was 73.7% at 5 years and 70.3% at 10 years for these patients, overall survival was 74.3% and 62.8% at 5 and 10 years for all patients. Prognostic factors for freedom from relapse were stage IV, B symptoms, age greater than 35 years and more than 3 involved lymph node regions. These factors also were relevant for overall survival, in addition mixed cellularity or lymphocyte depleted subtype, high erythrocyte sedimentation rate, failure to achieve a complete remission following initial treatment and relapse of Hodgkin's disease were identified as negative prognostic factors. Laparotomy staged patients who received radiotherapy only for stage I and II Hodgkin's disease had better outcome than clinically staged patients. Our data suggest that adequate therapy is able to reduce the impact of unfavourable prognostic factors. The outcome for patients with bulky mediastinal disease was similar to that in patients without a mediastinal mass.

Conclusions: The optimal choice of treatment for patients with early stage Hodgkin's disease--combined modality treatment/radiotherapy alone/chemotherapy alone?--and for patients with advanced stages--consolidation radiotherapy?--remains an unresolved issue and needs further testing in large randomized trials considering acute and late complications. Staging laparotomy may be used only for a small group of patients who would receive radiotherapy alone as definitive treatment. Modifications of therapy clearly reduce the impact of negative prognostic factors.