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EXTENSIONS OF DISEASE, COMPLICATIONS OF THERAPY, AND DEATHS IN LOCALIZED HODGKIN'S DISEASE; PRELIMINARY REPORT OF A CLINICAL TRIAL

JAMES J. NICKSON and G. B. HUTCHISON

The preliminary results in a clinical trial to evaluate limited (IF) and extensive (EF) radiotherapy for localized Hodgkin's disease are discussed.

At this early date there is no significant difference in mortality between the 2 regimens.

Complications of therapy are found to be significantly more frequent with the more extensive treatment, and extensions of Hodgkin's disease are more frequent with limited fields. It is suggested, however, that these 2 opposing effects are not of equal significance. The excess complications following EF therapy appear to represent all degrees of severity, with EF patients experiencing approximately twice as many mild complications and twice as many severe complications as is true for the IF patients.

The excess extensions of Hodgkin's disease noted in the IF series are confined to local extensions, involving lymph node areas on the same side of the diaphragm as the initial disease. Distant extensions, crossing the diaphragm or involving extra lymph node organs, are equally common in both treatment groups.

The long term significance of both complications and extensions is not yet known. While asymptomatic roentgenologic changes in the chest roentgenograms or Lhermitte's sign on neurologic examination are considered here to be nondisabling complications of therapy, subsequent follow-up may demonstrate a serious prognostic significance to these findings. Similarly, local extension of disease, controlled by later courses of limited radiotherapy, appears at this time to be a benign finding. The subsequent course may show that this delay in treatment of preclinical disease significantly reduces the likelihood of cure. The ultimate evaluation of these 2 therapeutic modalities will depend on the long term experience with respect to complications, extensions, and mortality.


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