Purpose: To summarize 30 years of experience in treatment of and prognosis for stage I Hodgkin disease.
Materials and methods: The authors reviewed retrospectively the cases of 196 patients seen and followed up at one institution from 1967 to 1997. All patients were treated with radiation therapy, and 46 also received combination chemotherapy as part of their initial treatment. Radiation therapy techniques included involved or regional-field irradiation in 83 patients, extended field irradiation (mantle or inverted Y) in 74, and subtotal nodal irradiation in 39 (median radiation doses for subclinical and clinical disease were 30 and 40 Gy, respectively, at 1.5-2.0 Gy per fraction). Of 46 patients treated with combination and radiation therapy, 26 received subtotal nodal irradiation; in the remaining 20, chemotherapy was combined with more limited-field radiation therapy. Follow-up ranged from 3 to 356 months (median, 144 months).
Results: The actuarial overall survival, disease-specific survival, and freedom from progression at 10 and 20 years were 82% and 66%, 94% and 91%, and 77% and 70%, respectively. In multivariate analysis, age adversely influenced overall survival, and female sex favorably affected freedom from progression. Mixed cellularity histology and mantle field technique adversely influenced disease-specific survival. Laparotomy significantly influenced disease-specific survival but not overall survival.
Conclusion: Radiation therapy results in an excellent outcome in patients with favorable stage I Hodgkin disease. Pathologic staging is no longer necessary.