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PS I-II STLI vs M: no difference in FFP

XRT, radiation therapy; IF, involved field; PS, pathologic stage; CS, clinical stage; EF, extended field; STLI, subtotal lymphoid irradiation; TLI, total lymphoid irradiation; FFP, freedom from progression; M, mantle field.

XRT, radiation therapy; IF, involved field; PS, pathologic stage; CS, clinical stage; EF, extended field; STLI, subtotal lymphoid irradiation; TLI, total lymphoid irradiation; FFP, freedom from progression; M, mantle field.

found an advantage to subtotal lymphoid irradiation versus involved-field radiation for clinical stage I and II patients, in which FFR was 59% versus 32%, which was a statistically significant difference.

The utility of clinical staging in the treatment of patients with HL without a staging laparotomy was documented by the EORTCH 6 Trial.5 In this study, favorable patients (defined as no more than two nodal sites; no B symptoms; no bulky disease; and an erythrocyte sedimentation rate <30 mm) were studied. These "favorable" patients (which constituted only 45% of patients with clinical stage I and II disease) were randomized to either subtotal nodal radiation therapy plus splenic radiation therapy versus staging laparotomy with treatment modified by the results of surgery and histology. If laparotomy was positive, patients received chemotherapy. Patients with a negative staging laparotomy, and lymphocyte predominant or nodular sclerosing histology, were treated with mantle radiation therapy alone, and other histologies received subtotal nodal radiation therapy plus splenic radiation therapy. In this study, DFS was not statistically different in the surgically staged group versus the clinically staged group. Note that 30% of patients had a positive staging laparotomy. Overall survival (OS), paradoxically, was slightly worse in the laparotomy arm (93% vs 89%). This may or may not have reflected acute or later complications as a result of surgery.

As clinical staging has become increasingly common, a majority of programs specializing in the care of lymphoma patients generally use subtotal lymphoid radiation therapy, or other modifications of extended field radiation therapy, when treating favorable stage I and II patients. Mantle radiation therapy alone is rarely used at the present time.

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