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Evidence for an Orderly Progression in the Spread of Hodgkin's Disease¹

Departments of Radiology and Medicine, Stanford University School of Medicine, Palo Alto, California

The sites of involvement of 100 unselected, untreated patients with Hodgkin's disease have been studied. The extent of disease was determined by detailed clinical laboratory and radiologic survey, including lymphangiography and biopsy of equivocally involved areas. The initial site of extension of disease after high dose irradiation has also been analyzed in the 26 patients who developed new areas of disease.

It is apparent that areas of involvement or extension of Hodgkin's disease are not random. Disease is found in adjacent lymphoid areas in the majority of patients. New areas of involvement were in areas immediately adjacent to the initial treatment fields in 22 of 26 patients. The mediastinum was the area most commonly skipped in the patients who demonstrated discontinuous involvement.

These observations support the concept that Hodgkin's disease arises in a single focus and spreads in a predictable manner along adjacent lymphoid channels. The therapeutic implications of these observations are presented.

¹ These investigations have been supported by Grant CA 05838 from the National Cancer Institute, NIH, Bethesda, Maryland.