Further follow-up of results of treatment in 90 laparotomy-negative Stage I and II Hodgkin's disease patients: significance of mediastinal and non-mediastinal presentations

A preliminary report described the results of radiotherapy treatment in 90 patients with laparotomy-negative stage I and II Hodgkin's disease. This group has now been followed a minimum of five years. The maximum follow-up is just over ten years. The findings in the preliminary report are now confirmed. The projected ten year survival is approximately 93%; the projected ten year disease free survival is about 60%. None of the patients received total nodal radiotherapy. More than half of the patients received no elective irradiation below the diaphragm and some of them received less than full mantle treatment. Present philosophy in the management of Hodgkin's disease is tentatively based on combining the results of the treatment of patients variously staged, either with or without laparotomy or with or without lymphangiography. Analysis of patterns of failure in patients who have had a laparotomy strongly suggests that a more conservative radiotherapy approach than is currently the norm in most institutions can be equally effective. Indications for a combined chemotherapy/radiotherapy program for mediastinal presentations are discussed