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Bulky mediastinal Hodgkin's disease management and prognosis
Author(s) -
Liew K. H.,
Easton D.,
Horwich A.,
Barrett A.,
Peckham M. J.
Publication year - 1984
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2900020106
Subject(s) - medicine , radiation therapy , disease , lymph node , adverse effect , chemotherapy , mediastinal lymph node , stage (stratigraphy) , surgery , survival rate , gastroenterology , cancer , metastasis , paleontology , biology
Of a total of 235 Stage I and II Hodgkin's disease patients treated between 1970 and 1979, 103 (43·8 per cent) had mediastinal involvement in 45 of whom the disease was bulky and in 58 non‐bulky. This report concentrates on bulky disease patients of whom 45 per cent did not relapse after therapy and 71 per cent are alive. Patients with mediastinal disease were treated with radiotherapy (63), sequential chemo‐radiotherapy (37) or chemotherapy alone (3). In the radiotherapy group the relapse rate for bulky disease was significantly higher (65 per cent) than for non‐bulky disease (44 per cent) ( P < 0·05) although there was no significant difference in survival. Neither relapse rate nor survival differed significantly in bulky disease patients treated with radiotherapy compared with combined chemo‐radiotherapy although there was a 20 per cent difference in relapse‐free survival rate in favour of the combined treatment group at five years. Treatments were not allocated randomly and the chemo‐radiotherapy group contained a disproportionate number of patients with adverse features (> 3 node areas involved, limited lung extension) compared with the irradiated group: 11/25 and 2/17 respectively. The number of lymph node areas involved appeared to influence the relapse rate in the radiotherapy group. There was no correlation between mediastinal mass size and number of node areas involved suggesting that these two features may be independent prognostic factors.