Can pelvic irradiation be omitted in patients with pathologic stages IA and IIA Hodgkin's disease?

From April 1969 to December 1973, 81 unselected laparotomy-staged IA and IIA patients with supradiaphragmatic Hodgkin's disease were treated at the Joint Center for Radiation Therapy. Mantle and para-aortic fields alone were treated to 3600-4000 rads. Median follow-up was 31 months. There were six relapses including three true recurrences, two extensions, and one extra-nodal dissemination. Relapses were not related to histologic type. There were no pelvic or inguinal extensions. Disease-free survival was 95% in stage IA patients and 86% in stage IIA patients. Only one patient died of disease, with an overall survival of 96%. These results indicate that mantle and para-aortic irradiation is sufficient treatment for pathologic stage I and IIA supradiaphragmatic Hodgkin's disease. Such treatment obviates the need for pelvic irradiation or combination chemotherapy without compromising the success of treatment.