RESULTS AND THERAPEUTIC CONSEQUENCES OF STAGING LAPAROTOMY IN HODGKINS-DISEASE

In order to define the role of staging laparotomy (LAP) in Hodgkin's disease, we analysed clinical and pathological findings in 282 newly diagnosed patients with clinical stages (CS) I-IIIA. They underwent diagnostic laparotomy with splenectomy as part of the staging procedure for the prospective therapy trials HD1, HD2 and HD3 of the German Hodgkin Study Group. Infradiaphragmatic disease was revealed in 115 patients: 29/66 (44%) in CS I, 58/186 (31%) in CS II and 28/30 in CS IIIA patients. No clinical findings could accurately predict infradiaphragmatic disease. In a therapeutic strategy that assignes patients in clinical stages I and II with a high risk for relapse and patients in clinical stage IIIA to a combined modality therapy (CMT), the results of LAP have little impact on the therapeutic approach. Only five of 61 patients (8%) with one of the risk factors 'large mediastinal mass', 'extranodal disease', 'clinically detectable splenic involvement' were downstaged and received only radiotherapy (RT) because clinically suspected infradiaphragmatic disease was excluded by the results of LAP. In contrast, in patients in CS I and II without these risk factors LAP revealed infradiaphragmatic involvement qualifying them for CMT instead of RT in 68/211 cases (32%). Considering additional risk factors, such as high ESR, three or more lymphatic areas involved, this proportion would be similar (35%). We conclude that patients without risk factors should continue to undergo staging laparotomy.