The influence of initial pathologic stage on the survival of patients who relapse from Hodgkin's disease.

Between April 1 969 and December 1 976. 31 7 surgically staged IA-IlIB Hodgkin’s disease patients were seen at the Joint Center for Radiation Therapy. Out of this group there have been 62 relapses. Fifty-eight of these 62 patients have completed their initial retreatment and make up the basis of this study. At the time of first relapse. retreatment consisted of chemotherapy in 53 patients, radiation therapy alone in 4 patients. and no treatment in 1 patient. The 4-yr actuarial survival following relapse is 60%. and the relapse-free survival is 55% with a median time off chemotherapy of 42 mo. The initial pathologic stage appeared to be the most important prognostic factor in predicting survival following relapse. Patients with initial stage IA, IIA. IIB. or Ills+N A disease had a 4-yr actuarial survival of 81 % compared with a survival of only 42% in patients with initial stage llIs,N+A or IlIB disease. The complete response (CR) rate following retreatment with chemotherapy at relapse was 86% in the former and 56% in the latter group. A complete response of 6 mo or greater duration was associated with a high probability of survival. and currently. 29 of 31 such patients are disease free. In contrast. only 2 of 22 patients without a CR or a CR of less duration following retreatment are NED. These data support the use of radiation therapy alone in the initial treatment of early stage Hodgkin s disease as the survival following retreatment with chemotherapy is excellent in the small proportion of patients who relapse. In contrast. patients who initially present with stage lIlAs+N, or IlIB Hodgkin’s disease have a poor survival following relapse. These patients should initially receive combined modality treatment or treatment with chemotherapy alone in attempt to reduce the high relapse rate following the use of radiation therapy alone.