Observations on the treatment of mediastinal masses in Hodgkin's disease emphasizing site of failure

Journal Article · Mon Jun 01 04:00:00 EDT 1987 · Am. J. Clin. Oncol.; (United States)

DOI:https://doi.org/10.1097/00000421-198706000-00001· OSTI ID:6473319

Ryoo, M C; Kagan, A R; Wollin, M; Nussbaum, H; Chan, P Y; Hintz, B L; Rao, A R; McMahon, J

Of 244 patients with Hodgkin's disease, 126 (52%) had an abnormal mediastinum. Sixty-four patients were treated with radiation, 36 with radiation and chemotherapy, and 25 with chemotherapy alone as an initial treatment. Twenty of 52 (38%) with stage I or II who received initially radiation alone relapsed, and 70% (14 of 20) of them were salvaged with chemotherapy. Therefore, the ultimate failure rate was 12% (6 of 52). Forty percent (8 of 20) of these patients failed within or at the margin of the radiation portal, and 60% failed predominantly outside of the radiation field. Even though we did not treat the whole lung prophylactically, there was only one true peripheral lung recurrence. Nine of 20 (45%) recurred in more than one site. Of 36 patients treated with combined radiation and chemotherapy, 21 patients had stage I, II, or IIIA disease. Of these, two patients relapsed. Of 86 patients with accessible x-ray films, 30 patients had large masses with a ratio of mass to transverse diameter greater than .33 at the broadest level. Fifty-six patients had small masses. Survival at 96 months in patients with stages I-IIIA with either large or small masses is 94% (p = 0.80). Their relapse-free survival at 96 months is 79% for large masses and 95% for small masses (p = 0.18). The site of relapse is discussed in detail in the text. There were five treatment-related deaths; three patients died of acute myelogenous leukemia. Our data do not support the role of whole-lung prophylactic irradiation or initial combined radiotherapy and chemotherapy in patients with large mediastinal masses.

• Research Organization: Southern California Permanente Medical Group, Los Angeles
• OSTI ID: 6473319
• Journal Information: Am. J. Clin. Oncol.; (United States), Journal Name: Am. J. Clin. Oncol.; (United States) Vol. 3; ISSN AJCOD
• Country of Publication: United States
• Language: English

Related Subjects

550600 -- Medicine
550603* -- Medicine-- External Radiation in Therapy-- (1980-)
62 RADIOLOGY AND NUCLEAR MEDICINE
ADRENAL HORMONES
BODY
BODY AREAS
CHEMOTHERAPY
CHEST
COMBINED THERAPY
CORTICOSTEROIDS
DISEASES
GLUCOCORTICOIDS
HEMIC DISEASES
HODGKINS DISEASE
HORMONES
HYDROXY COMPOUNDS
KETONES
LEUKEMIA
LUNGS
LYMPHOMAS
MEDIASTINUM
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANS
PATIENTS
POST-IRRADIATION EXAMINATION
PREDNISONE
PREGNANES
RADIOLOGY
RADIOTHERAPY
RESPIRATORY SYSTEM
STEROID HORMONES
STEROIDS
SURVIVAL TIME
THERAPY