Patient tolerance to extended irradiation in Hodgkin's disease

Increasing frequency of acute myeloid leukemia complicating Hodgkin's disease: a review

Between the years 1911 and 1969, there were 16 reported cases of Hodgkin's disease terminating in acute myeloid leukemia. During the period from 1970 to 1978, the number reported was 161. Other severe complications of Hodgkin's disease (second malignancies and infections) also seem to appear with increased frequency after the introduction of modern aggressive high-energy radiation therapy and combination chemotherapy. It is thus desirable to search for alternative methods of treatment of Hodgkin's disease.

Hodgkin's disease: unfolding concepts concerning its nature, management and prognosis

The evolution of our concepts concerning the fundamental nature and natural history of Hodgkin's disease is reviewed. Recent evidence establishes that it is indeed a malignant neoplasm, albeit a curious one, the giant cells of which display aneuploid karyotypes, often with marker chromosomes indicating their clonal derivation, and the functional and surface marker properties of cells of the mononuclear phagocyte series. The disease tends initially to spread by contiguity from one lymph node chain to others with which direct lymphatic channel communications exist. Essentially all patients, even those with limited disease, have some degree of impairment of cell-mediated immunity, apparently due to inhibition of T-lymphocyte function. Lymphangiography, computed tomography, and laparotomy with splenectomy have greatly improved the accuracy of clinical staging. Total lymphoid megavoltage radiotherapy and/or multidrug combination chemotherapy now permit the eradiction of disease of all stages, resulting in a dramatic improvement in prognosis and an increasing frequency of permanent cure of this once inevitably fatal condition.

Hodgkin's disease stage I and II. A comparison between two different treatment policies

A retrospective analysis was performed on 145 patients with Stage I and II Hodgkin's disease treated over an 11-year period. Sixty-two patients (Group I) received a mantle field without systematic irradiation of the para-aortic lymph nodes. Eight-three patients (Group II) received radiotherapy according to the folowing policy: all Stage IB and IIB and all mixed cellularity and lymphocytic depletion types received total nodal irradiation while stage IA and IIA nodular sclerosing and lymphocytic predominance cases received irradiation to a mantle field and to the para-aortic lymph nodes. The characteristics of the two groups were roughly comparable in age range, sex, staging, histopathologic subtypes and total irradiation doses. All patients had lymphangiograms although not all underwent staging laparotomies. The staging laparotomy did not appear to have an influence within each group. The extent of irradiation did significantly affect both the incidence of further manifestation of disease as well as survival rates. The frequency of lymph node extension, organ extension and local recurrence for Group I was 24%, 14%, and 3%, while for Group II it was 4%, 6%, and 6%, respectively. The seven-year absolute survival rate for Group I was 57% while for Group II it was 93%.

Hematologic and immunologic status in Hodgkin's disease 5 years after radical radiotherapy

The hematologic and immunologic status was evaluated after 5 years of continuously disease-free survival for 71 consecutive patients treated for Hodgkin's disease by radiotherapy. There was no evidence of residual hematologic depression, even in those patients treated initially with total nodal irradiation. Similarly, quantitative immunoglobulin levels were within the normal range, and the response to delayed hypersensitivity skin testing was intact in nearly all patients. These immunologic studies were consistent with the observed absence of an unusual incidence of infectious complications in these long-term survivors.

The management of stages I, II, and III Hodgkin's disease with combined radiotherapy and chemotherapy

An analysis and progress report is presented of the randomized clinical trials testing the value of adjuvant MOPP chemotherapy with irradiation in the management of Hodgkin's disease. The 213 patients with Stages IA through IIIB have been followed for periods of up to 64 months. The chemotherapy controls the occult disease, resulting in significant improvement in disease-free survival (p = .002). Over-all survival is not yet affected, however, with combined 5-year survival results of 92% and 88% in the two groups. The treatment program is difficult but feasible. No increased incidence of second malignancies has been observed in this study group. It is premature to conclude that adjuvant MOPP chemotherapy is indicated in the radiation management of Hodgkin's disease.

Total body irradiation (TBI) as primary therapy for advanced lymphosarcoma

The natural history of lymphocytic lymphomas is such that diffuse involvement usually is present at diagnosis. Extensive lymphatic irradiation with tumoricidal doses is seldom an appropriate form of treatment, as most patients require systemic therapy. We have investigated total body irradiation (TBI) as an alternative to chemotherapy. A series of 39 consecutive untreated patients with generalized disease is reviewed. Actuarial 5-year survival rates for the well-differentiated, poorly differentiated nodular, and poorly differentiated diffuse histologic types are 100%, 78%, and 56% respectively. The single major complication, acute myelocytic leukemia, has developed in 2 of the 8 patients given extensive nodal irradiation as a supplement to TBI. None of the 31 patients receiving only TBI as initial therapy has shown evidence of a myeloproliferative disorder to date.