Prognostic Classification of Hodgkin Disease in Pathologic Stage III, Based on Anatomic Considerations

Fifty-two patients with pathologic stage III Hodgkin disease were studied in an effort to determine whether location of involved abdominal nodes influenced survival. Treatment consisted of total nodal radiotherapy with or without subsequent combination chemotherapy. The initial radiation field was the “extended mantle,” which included supradiaphragmatic nodes, the splenic hilar area, and paraaortic nodes to the level of L2-L4. Subsequently, lower paraaortic and iliac regions were treated (“lower inverted Y”). Patients with disease limited to the spleen and/or splenic, celiac, or portal nodes (“anatomic substage” III1) had a more favorable 5-yr survival than did patients with involvement of paraaortic, iliac, or mesenteric nodes (“anatomic substage” lll2): 93% versus 57%, respectively (p < 0.05). The addition of combination chemotherapy to total nodal irradiation was associated with improved survival of patients in stage lll2, but not of those in stage III1.