Irradiation in the treatment of Hodgkin disease: a follow-up report

From 1971 through 1976, 167 patients with Hodgkin disease received radiation therapy. In 132, staging was determined upon laparotomy; the others had clinical staging. Most patients with stage I or II disease received either mantle or para-aortic-iliac irradiation, while the others received more extensive irradiation with or without chemotherapy. Overall five-year actuarial survival rate was 87%; Stage I, 97%; Stage II, 85%; and Stage III, 82%. Fifty-nine of the 167 patients had relapse of disease, and most relapses were seen in Stage II, located in the nodal sites on the opposite side of the diaphragm. Overall five-year relapse-free survival was 58%; Stage I, 94%; Stage II, 43%; and Stage III, 59%. Survival after the first relapse was 69%. Based on their results, the authors feel that Stage I disease of supradiaphragmatic presentation can be treated effectively with mantle field irradiation alone. In treating Stage II disease, mantle field irradiation alone was not optimal, and the authors recommend subtotal nodal irradiation