THE ROLE OF PROGNOSTIC FACTORS IN TREATMENT SELECTION FOR EARLY-STAGE HODGKINS-DISEASE

Purpose: To identify poor prognostic factors in early-stage Hodgkin's disease that predict a high rate of relapse after radiotherapy alone. Materials and Methods: A total of 153 patients with stages I and II supradiaphragmatic Hodgkin's disease, treated between 1964 and 1986 with either radio-therapy alone (120 patients) or combined modality therapy (33 patients), were studied retrospectively to determine factors affecting freedom from relapse and absolute survival. Median follow-up was 13 years. Clinical factors were assessed by the stepwise use of a stratified log-rank test and included maximum tumor dimension in any site (less-than-or-equal-to 6 cm or >6 cm), age (less-than-or-equal-to 40 or >40), presence or absence of B symptoms, pathologic and clinical stages (I or II), number of sites involved (less-than-or-equal-to 4 or >4), gender, histologic subtype, and large mediastinal mass (none, small [less-than-or-equal-to 6 cm], large [>6 cm]). Results: The only factors independently predicting a high rate of relapse were tumor dimension (>6 cm) and number of sites (>4 sites). At 10 years, in patients with and without the two poor prognostic factors treated with radiotherapy alone, the freedom from relapse rates were 5 3% and 84% (p < .0001) and the absolute survival rates were 72% and 85% (p = .004), respectively. Combined modality therapy significantly improved freedom from relapse, but not absolute survival, in patients with one or both poor prognostic factors. Conclusions: Two poor prognostic factors were identified that were highly significant in predicting a high risk of relapse after radiotherapy alone. The addition of three cycles of chemotherapy to standard radiotherapy significantly reduced the relapse rate in high-risk patients.