Prognosis of bulky Hodgkin's disease treated with chemotherapy alone or combined with radiotherapy.

The medical records of 396 consecutive patients with a histological diagnosis of Hodgkin's disease were reviewed to assess the prognostic importance of bulky and non-bulky lymphomas. The presence of large lymphadenopathy failed to affect significantly the seven-year results in terms of complete remission (bulky 81.1% v. non-bulky 86.2%), freedom from progression (60.7% v. 65.6%), relapse-free survival (75.1% v. 76.5%) and overall survival (62.7% v. 68.9%). It is noteworthy that in all subsets, ABVD (Adriamycin + bleomycin + vinblastine + dacarbazine), either combined with irradiation or alternated with MOPP (mechlorethamine + vincristine + procarbazine + prednisone), yielded superior results compared with MOPP with or without irradiation. Given the prognostic importance of various bulky sites, the presence of large lymphadenopathy in anatomic regions other than the mediastinum failed to affect results adversely. On the contrary, in patients in stages IIB-IIIA-IIIB, treated with combined modality, the presence of bulky mediastinal involvement did influence prognosis compared with patients with positive but non-bulky mediastinum. At seven years the results were 60.2% v. 79.9% for freedom from progression, 73.2% v. 89.9% for relapse-free survival and 64.8% v. 87.1% for total survival, respectively (P less than 0.03). By contrast, in patients with stage IV disease the extent of mediastinal involvement did not affect results. Nonetheless, the frequency of intrathoracic relapses was higher (26.7%) in patients given chemotherapy alone compared with patients treated with combined modality (11.5%).