ELSEVIER Radiotherapy and Oncology 39 (1996) l-7 Radiotherapy for early infradiaphragmatic Hodgkin’s disease: the Australasian experience M. Bartonlca, J. Boyagesa,E. Crennand, S. Davisd, R.J. Fisherb, C. Hook’, N. Johnsonc, D. Joseph’, V. Khooa, K.H. Liewd, G. Morgan’, P. O’Briene, S. Pendleburya, G. Pratt’, G. Quongg, D.E. Roose, D. Thomtonh, G. Trotter’, Q. Walker’, M. Wallington” aDivtsion of Raaktlon Oncology, Westmead Hospital, Westmead, NS W 2145. Australia bDepartment of Radtiztion Oncology. Prince of WalesHospital, Randwick, NSW 2031, Australia ‘Department of Radiation Oncology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia ‘Peter MacGzlhon Cancer institute, Melbourne. VIC 3000, Australia ‘Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA 5&W, At&ral& rQueenshmd Radium Institute, Herston, QLD 4006. Australia BHeitklberg Radiotherapy Centre, Repatriation Hospital, Hehielberg West, VIC 3081, Australia hW&n Valley Hospital, Woakn,ACT 2606, Australia iDepartment of Radiotherapy, Waikato Hospital, Hamilton, New Zealand iDepartment of Radiation Oncology, Mater Hospital, Newcastle, NS W 2300, Australia ‘Department of Radiation Ckology, St. Vincent’s Hospital, Darlinghurst, NSW 2010. Australia ‘Data knagementt, Department of Radiation Oncology, Prince of WalesHospital, Randwick, NSW 2031, Australia Received 4 August 1995;revised 2 January 1996;accepted 17 January 1996 AllShCt Purpose:To review the Australasian results of Stage I and HA Infradiaphragmatic Hodgkin’s Disease (IHD) treated solely by irradiation. Methods and murerials: Eligible patients had IHD only and were treated by irradiation with curative intent over the period of 1969 to 1988. Ten radiation oncology centres from within Australia and New Zealand were surveyed for patient, tumour and treatment variables. Disease free rates, survival and complications were analysed. Results: 106patients with IHD were studied. The averagepotential follow up was 9.4 years. The male to female ratio was 3.3:1. The median age was 37.5 years. Histological subgroups were as follows; lymphocyte.predominant 43%, mixed cellularity 21%, lymphocyte depleted 5%, nodular sclerosing 27% and unclassifiable 4%. Fifty nine patients had laparotomy of which 22 (37%) were positive for tumour. Nine laparotomies were performed for diagnosis and the remainder for staging. One patient was up-staged by laparotomy and three were down-staged. Sixty-eight patients presentedwith inguinal disease alone, five with abdominal disease alone, 19 with two sites of involvement and 12 with inguinal, pelvic and abdominal disease.In two patients the site was unknown. There was no correlation between site of involvement, age, sex or histological subtype. Forty sevencases were clinically staged(CS) as follows: CS IA - 23, CS IIA - 24. The other 59 were pathologically staged (PS) as follows: PS IA - 37, PS IB - 1, PS IL4 - 21. Treatment consisted of involved field alone (16), inverted Y (68), inverted Y and spleen (13), para-aortic irradiation only (3), or total nodal irradiation (6). Mean dose was 37 Gy. There were 30 recurrences to give an actuarial IO-year disease-free rate of 70%. In multivariate analysis lower number of ttmrour sites, lymphocyte predominant histology and higher dose were all significantly correlated with higher disease free rates. Eight patients died of Hodgkin’s disease and 19 of other causes. The IO-year overall survival rate was 71%. Older age and higher number of disease siteswere significantly correlated with shorter survival. Fourteen of 30 relapses may have beenavoid- able by the use of total nodal irradiation. In particular ten of 21 patients with abdominal disease relapsed in nodal sites which would have beencovered by total nodal irradiation. Conclusions: The rate of control in IHD could perhapsbe improved by avoiding involved field irradiation or by aggressive therapy with total nodal irradiation or combined modality chemo-irradiation in Stage II disease. Staging laparotomy does not appear to be indicated. Keywords: Infradiaphragmatic Hodgkin’s disease;Australasian survey; Radiotherapy l Corresponding author, Phone: 6128456499; Fax: 6128915814. 0167-8140/96/$15.00 0 1996 Elsevier Science Ireland Ltd. All rights reserved PII: SO167-8140(96)01715-X