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Results of a Prospective Trial of Mantle Irradiation Alone for Selected Patients With Early-Stage Hodgkin’s Disease

From the Department of Radiation Oncology, Brigham and Women’s Hospital, Department of Adult Oncology, Dana-Farber Cancer Institute, and Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and Department of Radiation Oncology, Duke University, Durham, NC.

Address reprint requests to Peter M. Mauch, MD, Department of Radiation Oncology, Brigham and Women’s Hospital, ASB1-L2, 75 Francis St, Boston, MA 02115; email: pmauch{at}lroc.harvard.edu

PURPOSE: To determine the efficacy of mantle radiation therapy alone in selected patients with early-stage Hodgkin’s disease.

PATIENTS AND METHODS: Between October 1988 and June 2000, 87 selected patients with pathologic stage (PS) IA to IIA or clinical stage (CS) IA Hodgkin’s disease were entered onto a single-arm prospective trial of treatment with mantle irradiation alone. Eighty-three of 87 patients had 1 year of follow-up after completion of mantle irradiation and were included for analysis in this study. Thirty-seven patients had PS IA, 40 had PS IIA, and six had CS IA disease. Histologic distribution was as follows: nodular sclerosis (n = 64), lymphocyte predominant (n = 15), mixed cellularity (n = 3), and unclassified (n = 1). Median follow-up time was 61 months.

RESULTS: The 5-year actuarial rates of freedom from treatment failure (FFTF) and overall survival were 86% and 100%, respectively. Eleven of 83 patients relapsed at a median time of 27 months. Nine of the 11 relapses contained at least a component below the diaphragm. All 11 patients who developed recurrent disease were alive without evidence of Hodgkin’s disease at the time of last follow-up. The 5-year FFTF in the 43 stage I patients was 92% compared with 78% in the 40 stage II patients (P = .04). Significant differences in FFTF were not seen by histology (P = .26) or by European Organization for Research and Treatment of Cancer H-5F eligibility (P = .25).

CONCLUSION: Mantle irradiation alone in selected patients with early-stage Hodgkin’s disease is associated with disease control rates comparable to those seen with extended field irradiation. The FFTF is especially favorable among stage I patients.

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				A. Ng, S Li, D Neuberg, D. Fisher, C McMillan, B Silver, K. Marcus, M. Stevenson, and P. Mauch Long-term results of a prospective trial of mantle irradiation alone for early-stage Hodgkin's disease Ann. Onc., November 1, 2006; 17(11): 1693 - 1697. [Abstract] [Full Text] [PDF]

				M. Ozsahin Early-Stage Hodgkin's Disease: To Mantle or Not to Mantle? J. Clin. Oncol., July 1, 2001; 19(13): 3298 - 3299. [Full Text]