Limited extranodal Hodgkin's disease: Unfavorable prognosis and therapeutic implications

The Ann Arbor Conference on the staging of Hodgkin's disease suggested that the prognosis in patients with “E” stage Hodgkin's disease is similar to that in comparable patients with only nodal disease. A comparative analysis was undertaken of 84 patients with pathologically staged IIA to IIIA disease and 18 patients with stage II EA to III EA disease. The lung was the principal site of extranodal extension (15 patients). Both groups were treated concurrently with either extended field irradiation alone or limited field irradiation followed by MOPP chemotherapy (nitrogen mustard, vincristine, procarbazine and prednisone). Relapse rates after irradiation alone were 29 per cent for the patients with stage HA to IIIA disease and 82 per cent for the patients with “E” stage disease. Patients who received adjuvant chemotherapy had relapse rates of 6 per cent and 14 per cent, respectively. Most “E” stage relapses were regional recurrences within the lung parenchyma. Wilcoxon analysis revealed a significantly shorter remission duration and survival for the patients with “E” stage disease after irradiation alone, but there were no differences between the two patient populations treated with irradiation followed by chemotherapy. These data indicate that the prognosis in patients with “E” stage Hodgkin's disease of the lung is poor when they are treated with irradiation alone, and that adjuvant chemotherapy should be considered for such patients.