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Long-Term Results of Radical Radiotherapy in Hodgkin's Disease

Christic Hospital and Holt Radium Institute, Manchester, England

A series of 1276 histologically proven cases of Hodgkin's disease is analyzed. The primary treatment was roentgen therapy followed, when systemic symptoms developed, by chemotherapy. All treated cases were followed up for a minimum of 5 years and a maximum of 15 years after treatment. Though the 15-year survival rate of patients with "generalized" lymphadenopathy (with or without systemic symptoms) was poor, very gratifying results were found in those patients whose lymph node involvement at the time of treatment was still localized to 1 single or 2 contiguous anatomic sites. A series of 213 patients diagnosed as having either localized lympho- or reticulosarcoma was also analyzed and found to have survival rates at 5, 10, and 15 years remarkably similar to those with Hodgkin's disease. Yet another series of 493 patients in whom the histologic report, though indicating a malignant lymphoma, was in some way disputatious, enjoyed survival rates not significantly different from the other 2 groups of patients. It seems obvious that, however we may classify malignant lymphoma, the urgent need is to treat the patient radically with X-rays at the earliest opportunity.

Some 10 years after treatment more than 40% of the patients with localized Hodgkin's disease were alive and well, and were shown to have a life expectancy similar to that of the general population of the same age and sex. This indeed provides a valuable definition of definitive cure.

The better prognosis usually claimed for females was substantiated in this series of Hodgkin's patients, but the impact of age on prognosis was found to be confined to females and the difference between the younger and older age groups was highly significant statistically. The implications for further investigation of these extreme categories are obvious.