Assessment of Favorable (F) Versus Unfavorable (U) Early Stage Hodgkin’s Disease (HD); the Stanford V + Radiotherapy (RT) Experience.

Early stage favorable HD is defined at Stanford and most US centers as stage I/II A and a mediastinal mass ratio (MMR) < 1/3 of the intrathoracic diameter. Within these parameters, we treated 101 patients (pts) with 8 weeks of Stanford V chemotherapy followed by 30 Gy (n = 84) or 20 Gy (n = 17) RT to involved sites. Seven pts had sites >10 cm (2 mediastinal and 5 nodal). At a median followup (f/u) of 5.5 years (y) the freedom from progression (FFP) was 96% with an overall survival (OS) of 98%. Stage I/II patients with MMR >1/3 of the intrathoracic diameter (n = 54) were treated with 12 weeks of Stanford V chemotherapy and 36 Gy RT to sites ≥5 cm. In this large MMR group the FFP and OS were 92% at a median f/u of 8 y. Other groups (EORTC, GHSG, NCI-C and GELA) have stratified early stage patients as favorable (F) and unfavorable (U) based on several risk factors. In addition to MMR and symptoms, these systems include age, # of nodal sites, sedimentation rate (ESR), extranodal lesions and in the GELA, elements of the international prognostic score for advanced HD. Phase III clinical trials have employed different therapies for F and U early stage pt based on these factors. We therefore retrospectively applied these factors to our “favorable” Stanford V pt to determine if they were prognostic as shown.

ifferences in FFP and OS were significant using EORTC criteria. Notably, the majority of our pt were U (including all from Kaiser) according to GHSG criteria. Among 5 relapsed pt, 4 had ≥ 3 nodal sites and 3 had ESR ≥50. All relapses were in the RT field, one combined with distant disease. Secondary therapy was successful in 4 pts although one transplant-related death occurred. In conclusion, stage I-IIA pts with MMR <1/3 treated with Stanford V + 20–30 Gy had excellent overall outcome but application of stratification factors used by other groups, particularly the EORTC, defined a less favorable subset. As HD therapy moves to further reductions in chemotherapy and RT or chemotherapy alone for early stages, these risk factors take on added importance in the interpretation of current trials results and design of future studies.