Assessment of Favorable (F) Versus Unfavorable (U) Early Stage Hodgkin’s Disease (HD); the Stanford V + Radiotherapy (RT) Experience.

Early stage favorable HD is defined at Stanford and most US centers as stage I/II A and a mediastinal mass ratio (MMR) 10 cm (2 mediastinal and 5 nodal). At a median followup (f/u) of 5.5 years (y) the freedom from progression (FFP) was 96% with an overall survival (OS) of 98%. Stage I/II patients with MMR >1/3 of the intrathoracic diameter (n = 54) were treated with 12 weeks of Stanford V chemotherapy and 36 Gy RT to sites ≥5 cm. In this large MMR group the FFP and OS were 92% at a median f/u of 8 y. Other groups (EORTC, GHSG, NCI-C and GELA) have stratified early stage patients as favorable (F) and unfavorable (U) based on several risk factors. In addition to MMR and symptoms, these systems include age, # of nodal sites, sedimentation rate (ESR), extranodal lesions and in the GELA, elements of the international prognostic score for advanced HD. Phase III clinical trials have employed different therapies for F and U early stage pt based on these factors. We therefore retrospectively applied these factors to our “favorable” Stanford V pt to determine if they were prognostic as shown. ifferences in FFP and OS were significant using EORTC criteria. Notably, the majority of our pt were U (including all from Kaiser) according to GHSG criteria. Among 5 relapsed pt, 4 had ≥ 3 nodal sites and 3 had ESR ≥50. All relapses were in the RT field, one combined with distant disease. Secondary therapy was successful in 4 pts although one transplant-related death occurred. In conclusion, stage I-IIA pts with MMR