Treatment of subdiaphragmatic Hodgkin's disease: long-term results and side effects

Oncol Rep. 1998 Nov-Dec;5(6):1513-8. doi: 10.3892/or.5.6.1513.

Abstract

To evaluate the results, prognostic factors and especially side-effects of the treatment for subdiaphragmatic Hodgkin's disease (SHD) a retrospective study was conducted in the Haematology Departments and in the Cancer Centres of Nancy and Strasbourg between 1976 and 1990; 55 patients corresponding to the IA to IIB SHD stages were analysed. The median age was 45 years. In accordance with Ann Arbor classification, we observed 12 CS IA (21.3%), 2 CS IB (3.5%), 14 CS IIA (25.4%) and 27 CS IIB (49.7%). Twenty-five patients (45.4%) underwent laparotomy with spleen involvement in 10 cases. Fifteen patients (27.3%) had exclusive radiotherapy, 10 by inverted-Y field with or without splenic field, 5 by limited field to inguinal and homolateral iliac nodes. Forty patients had prior chemotherapy, 18 by MOPP protocol, 18 by hybrid MOPP/ABVD protocol and 4 by other schemes. The total dose delivered ranged from 26 to 45 Gy. With a median follow-up of 8 years, the overall and disease specific survival rates are respectively 61% and 83% at 10 years. Nine patients relapsed (16.4%), 4 among the 15 (26.6%) treated by exclusive irradiation and 5 among the 40 (12.5%) treated by combined therapy. We observed 8.3%, 21.4% and 18.5% of relapses respectively among the clinical stages IA, IIA and IIB. Eleven patients (20%) developed a second cancer. Twenty-six long-term complications were noted, nine of which concerned the digestive system. The only significant prognostic factor is age, with 10-year specific survival rates of 96% and 66% respectively for patients younger and older than 50 years (p=0.0003). Our data confirm that the most appropriate treatment for stage IA is exclusive radiotherapy and combined therapy for all other cases. With the use of CT-scan and eventually lymphography, the laparotomy is reserved only for cases with an uncertain diagnosis. Tobacco use is also clearly a risk factor in our series for late vascular complications and second cancers.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bleomycin / administration & dosage
  • Child
  • Child, Preschool
  • Cisplatin / administration & dosage
  • Dacarbazine / administration & dosage
  • Diaphragm
  • Disease-Free Survival
  • Doxorubicin / administration & dosage
  • Etoposide / administration & dosage
  • Female
  • Follow-Up Studies
  • France
  • Hodgkin Disease / drug therapy*
  • Hodgkin Disease / mortality
  • Hodgkin Disease / pathology
  • Hodgkin Disease / radiotherapy*
  • Humans
  • Incidence
  • Male
  • Mechlorethamine / administration & dosage
  • Middle Aged
  • Neoplasm Staging
  • Neoplasms, Second Primary / epidemiology
  • Prednisone / administration & dosage
  • Procarbazine / administration & dosage
  • Prognosis
  • Radiotherapy / adverse effects
  • Radiotherapy Dosage
  • Retrospective Studies
  • Splenic Neoplasms / drug therapy
  • Splenic Neoplasms / mortality
  • Splenic Neoplasms / pathology
  • Splenic Neoplasms / radiotherapy
  • Survival Rate
  • Time Factors
  • Vinblastine / administration & dosage
  • Vincristine / administration & dosage

Substances

  • Bleomycin
  • Procarbazine
  • Mechlorethamine
  • Vincristine
  • Vinblastine
  • Etoposide
  • Dacarbazine
  • Doxorubicin
  • Cisplatin
  • Prednisone

Supplementary concepts

  • ABVD protocol
  • EAP protocol
  • MOPP protocol