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A study of relapse and course of 153 cases of Hodgkin's disease (clinical stages I and II) treated at the institute gustave‐roussy from 1963 to 1970 with radiotherapy alone or with adjuvant monochemotherapy

Seventy‐three relapses were observed among 153 patients with Hodgkin's disease, clinical Stages I and II, who underwent treatment between 1963 and 1970. Treatment consisted of radiotherapy to the involved side of the diaphragm alone or followed by two years of weekly injections of Vinblastine® Half these patients had been included in the EORTC H1 trial, and the relapse‐free rate and survival rate of our study were similar to those observed in that investigation. The relapse‐free rate was higher for the group receiving combination therapy; the difference in survival, although smaller than the difference in relapse‐free rates, is significant. Among patients with poor prognostic factors, the survival rate was significantly higher for those who received monochemotherapy. The addition of chemotherapy did not significantly improve the survival rate for patients with good prognostic factors of the 73 patients who had relapses, 12 (16%) died during the first relapse, 23 (32%) are relapse‐free and the Hodgkin's disease appears to be cured, and 38 (52%) experienced second relapses. The durations of the first and the second remissions were related. The survival rate was about 50% at five years after the first relapse; the rate was slightly lower for patients with relapses at extranodal sites. For the small group with marginal recurrence, the prognosis appeared to be better. The survival rate after relapse was not significantly influenced by the type of initial treatment. The incidence of transdiaphragmatic spread of the disease was 29% (40 of 137) for those with supradiaphragmatic disease and 63% (10/16) for those with subdiaphragmatic disease (clinical Stages I and II). It was as high as 75% for those with clinical Stage II subdiaphragmatic disease of the 32 splenectomies performed after relapse, 20 revealed splenic involvement. Histologic slides were initially classified and then reviewed blindly in 1975 by the same team of pathologists. The survival rate for those whose histologic type had changed between the first and second reading was significantly lower than that for those who remained in the same histologic group.