Hodgkin's disease with direct extension into pulmonary parenchyma from a mediastinal mass: a presentation requiring special therapeutic considerations.

The significance of limited extranodal Hodgkin's disease involving pulmonary parenchyma by direct extension from a mediastinal mass (E stage) was evaluated in 177 patients with stages IA-IIIB. Disease-free and total survival rates of four groups were compared: 58 patients without and 13 patients with pulmonary E stage treated with radiotherapy followed by six courses of MOPP (mechlorethamine, vincristine, procarbazine, and prednisone), and 86 patients without and 20 patients with E stage treated with radiotherapy alone. The 12-year disease-free and total survival rates projected by life-table analysis were significantly poorer for E stage patients treated with radiotherapy alone. It is concluded that pulmonary E stage requires special therapeutic considerations if end results are to equal those obtained with standard radiotherapy for Hodgkin's disease confined to lymph nodes, and that combined modality therapy is one method by which pulmonary E stage may be treated successfully.