Infradiaphragmatic Hodgkin's disease: the Swedish National Care Programme experience

Abstract: A Swedish national care programme has provided guidelines for staging, treatment and follow‐up of all patients with Hodgkin's disease (HD) since 1985. Between January 1985 and December 1992, 920 patients were reported and followed prospectively. Of a total of 533 patients with stage I and II disease, 484 presented with supradiaphragmatic HD and 49 (9%) with infradiaphragmatic HD. The median follow‐up time was 4.3 yr (3.3–10 yr). Significant differences in average age (45±21 yr and 55±19 yr), male: female ratio (1.1 : 1 and 2.8 : 1) and B‐symptoms (25% and 47%) were observed in patients with supra‐ and infradiaphragmatic HD, respectively. Forty‐six patients with infradiaphragmatic HD were treated with a curative intention and 40 (87%) achieved a complete response. Eleven (28%) of the 40 patients have recurred and 8 patients have died of HD. Complete response rates and recurrence frequencies did not differ from those observed in patients with supradiaphragmatic HD. Mortality was, however, significantly higher ( p =0.001) in the infradiaphragmatic group; this was due mainly to poorer effects of salvage treatment in an elderly population. In this population‐based study, patients with peripheral disease in stage IA respond well to inverted Y irradiation alone, whereas it appears to be important to give stage II patients chemotherapy or a combined modality treatment in order to avoid unacceptably high recurrence rates.