Seventy-one patients with Hodgkin's disease who were initially treated at Johns Hopkins with radiation or radiation-chemotherapy from 1975-1980 had a five-year cumulative disease-free survival of I-A-100% (12 patients); II-A-85% (33 patients); II-B-83% (seven patients); 111-A-75% (ten patients); and 111-B-66% (nine patients). Fifty patients with mediastinal masses at the time of treatment demonstrated no marginal misses, two mediastinal recurrences (96% local control), and three lung disseminations. CT scan data yielded stage and treatment modification in 60% (9/15) of recent patients with mediastinal Hudgkin's disease. This demonstrates the need for routine thoracic scans and individual treatment planning in all mediastinal cases. Recommendations for combination treatment in early stage disease are made only for pericardial or extrathoracic chest wall extension based on CT scan findings, our low failure rates, radiation organ tolerances, and available relapse data in the literature, not arbitrary size designations from upright chest radiographs. It can be concluded that patients with mediastinal Hodgkin's disease require CT scan analysis to identify unusual patterns of presentations, sites at risk, and to allow for proper application of radiation portals and/or chemotherapeutic management.
Cancer 492267-2275, 1982.
ARIOUS AUTHORS have reported a high rate of local V relapse and lung dissemination in Hodgkin's disease presenting with large mediastinal masses that have been treated with radiation alone.'-' Furthermore, other authors have suggested that chemotherapy fails in sites of bulk disease and relapse occurs earlier and more often in nodular Nodular sclerosis constitutes 50-94% of large mediastinal mass presentation~.'*~~' Combination therapy'."'-" or whole-lung radiation2*12 has been suggested, based on several studies that imply poor results obtained with radiation treatment alone in large mediastinal mass presentations. Parameters utilized to assess sites of involvement and bulk of disease in these previous studies have been limited to conventional radiography or t~mography.'-'***~~'~
The intent of this report is to present the evidence that CT scanning is valuable in achieving accurate staging and in delineating disease previously unrecognized by other tests. We also briefly review our treatment results with patients carefully staged from 1975-1980.