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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An autopsy study was performed on 190 cases with Hodgkin's disease and on 134 cases with reticulum cell sarcomas. It was found that a cascade spread of metastases, as opposed to a random spread, was detectable in patients with Hodgkin's disease, but not in patients with reticulum cell sarcoma. Metastatic key-sites for both lymphomas are defined as those organs whose chance of being seeded by the primary tumor is the highest; these sites are the spleen, liver, bone marrow and lungs. This study could not demonstrate in Hodgkin's cases that metastases in the liver and bone marrow were spleen dependent, but rather it showed that the spleen, liver and bone marrow acted as three independent sources of generalized metastases. Explanations proposed to account for the different metastatic spread in Hodgkin's disease and reticulum cell sarcomas, included different intrinsic cellular characteristics of the two lymphomas. the different location of the primary tumor either because of nodal, or of extra nodal origin, or because the primary tumor was located either in the upper or in the lower torso or in both areas. Malignant cells in the kidney, central nervous system and endocrine system were either released by the spleen via the lungs, or released by the liver and the lungs, or they were bone marrow dependent. The cascade spread of metastases hold true only for Hodgkin's disease. In cases with reticulum cell sarcomas, metastases appeared to spread at random from the primary tumor throughout the body, with rare exceptions such as metastases in the central nervous system, which originated either in the liver or in the spleen, lungs, kidney and bones.
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PMID:The spread of blood-borne metastases in malignant lymphomas of man. 79 73

Sifting the preceding factors, which may weigh for or against routine laparotomy and splenectomy as a staging procedure in Hodgkin's disease, we advocate that one be sure the diagnosis and histologic classification are confirmed by an experienced hematologic pathologist, that complete clinical studies for clinical staging with the exception of the lymphangiogram be performed, and that a laparotomy and splenectomy be performed in appropriate centers for clinical Stages I through III and unconfirmed Stage IV patients unless some contraindication is present. The subdiaphragmatic nodal areas should not be irradiated without evidence of the presence of disease in these areas. A minimum of 4,000 rads of supervoltage therapy should be delivered to the areas known to be involved with Hodgkin's disease plus the neighboring lymph node areas, using total nodal irradiation only on definite indication but not prophylactically.
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PMID:Recent advances and controversies in the management of Hodgkin's disease. 80 22

The treatment of choice for lymphomas in general and 1st and 2nd stage Hodgkin's disease in particular in high-energy radiotherapy. This has led to improved results, especially with respect to survival. The most effective techniques are those directed to all the lymph nodes, including the spleen "total nodal irradiation". Supradiaphragmatic areas are managed by means of Kaplan's mantle technique, whereas the wide-field upside-down Y technique is used below the diaphragm. These new methods are described and statistics relating to their employment published by Stanford University and the National Cancer Institute are cited.
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PMID:[Radiotherapy of lymphomas]. 80 85

Continuing efforts are being made by clinical radiotherapists to evaluate radiationcomplications to normal tissue and organs by specific time-dose parameters. Currently,the NSD concept of Ellis is receiving wide application in the literature in the reporting of radiation complications and normal tissue tolerances. To afford an easy and broad application of the NSD concept to the evaluation of physiological, functional, or structural changes, the authors have evolved mathematical expressions for the calculations of NSD as a function of patient thickness, beam energy, SSD, and treatment schedule involving coplanar field arrangements whether the fields are treated alternately or simultaneously. Several interesting aspects evolving form the concepts of treatment planning interms of the NSD or biological effects indicate that 1) for beam energies above 22 MeV, treatment is more ideally performed by treating only one field per day, since the depth of electronic equiliberium provides more effective sparing of superficial organs andtissues; 2) large-field therapy, such as the total nodal irradiation of Hodgkin'sdisease, can be more effectively treated in terms of tissue sparing by higher energy beamsthan cobalt-60 or 4-MeV for practically all patient dimensions; 3) a new concept ofintegral biological dose,the "gram-ret", is proposed, which represents the quantitation of total biological effect; 4) a series of tables with multiplication factors programmed on a digital computeris presented, which very quickly make available the NSD in any fractionated radiation treatment cycle to any plane of the body as a fuction of the beam energy, SSD, patient thickness, and continuous or split-course therapy schedule.
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PMID:Biological effects evaluated as a function of patient thickness, beam quality, SSD,and treatment schedule. 80 15

Trying to establish the eventual interrelations of the initial histologic nodal type and the splenic one, the general lymphographic picture, the histologic nodal type and spleen involvement, lymphographic and histologic examinations were carried out in 151 patients with Hodgkin's disease. Lympographies were performed in 139 cases, and splenectomy (followed by splenic, hepatic and abdominal lymph node biopsies) in 32. Lymphocyte depletion was found in 72.7% of the patients with lymph node obstruction diagnosed lymphographically. Splenic involvement was more frequent in cases with pathologic lymphographic picture and histologic aspects of lymphocyte predominance or nodular sclerosis. In patients with initial nodal histologic types of nodular sclerosis or lymphocyte depletion, the splenic histopathologic types were the same, but they got more severe in cases with lymphocyte predominance or mixed cellularity. Splenic biopsy might be unconclusive after protracted cytostatic treatment or splenic X-ray therapy. In the authors' opinion, early routine splenectomy is rather more advisable than differentiated splenectomy.
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PMID:Relationships between lymphography and the histologic nodal and splenic types in Hodgkin's disease. Considerations on clinical evolution. 84 Dec 53

A patient who had clinical stage IA Hodgkin's disease involving a single group of epitrochlear nodes is presented. A few patients with this disease have been reported to have involvement of epitrochlear lymph nodes, but none have had disease limited to this nodal site. At staging laparotomy a single focus of Hodgkin's disease was found in the spleen. Theoretical aspects of the mode of spread of Hodgkin's disease are discussed with respect to this case.
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PMID:Hodgkin's disease presenting in epitrochlear lymph nodes. 85 Aug 24

Certain features of nodular sclerosing Hodgkin's disease predispose toward achievement of excellent radiotherapeutic results using clinical staging rather than currently advocated surgical staging including laparatomy. These include a distinct pattern of contiguous lymphatic involvement and the infrequent dissemination of disease to extranodal sites in early stage patients. Only three of 58 consecutive Clinical Stage I-III patients initially treated with radiotherapy alone between 1965 and 1969 have died from Hodgkin's disease. The 10-year survival rates corrected for intercurrent deaths are 97%, 90%, and 86% for Stages I-IIA, IIB, and III respectively. The usual prognostic influence of "B" symptoms was not evident following extended prophylactic irradiation. Likewise, there was no discernible influence of the subtype (lymphocyte predominant, mixed cellularity, lymphocyte depletion) on survival with these nodular sclerosis patients. There was a single extension of disease to iliac nodes in 46 patients with supradiaphragmatic involvement for whom prophylactic irradiation did not extend below the aortic bifurcation, providing justification for modified total nodal irradiation. Development of extranodal dissemination was observed in only 4/58(7%) patients, indicating that adjuvant chemotherapy is not warranted or justified in the early stages of nodular sclerosing Hodgkin's disease.
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PMID:Radiotherapy results for nodular sclerosing Hodgkin's disease after clinical staging. 85 40

Fifty-two patients with pathologic stage III Hodgkin disease were studied in an effort to determine whether location of involved abdominal nodes influenced survival. Treatment consisted of total nodal radiotherapy with or without subsequent combination chemotherapy. Th initial radiation field was the "extended mantle," which included supradiaphragmatic nodes, the splenic hilar area, and paraaortic nodes to the level of L2-L4. Subsequently, lower paraaortic and iliac regions were treated ("lower inverted Y"). Patients with disease limited to the spleen and/or splenic, celiac, or portal nodes ("anatomic substage" III1) had a more favorable 5-yr survival than did patients with involvement of paraaortic, iliac, or mesenteric nodes ("anatomic substage" III2): 93% versus 57%, respectively (p less than 0.05). The addition of combination chemotherapy to total nodal irradiation was associated with improved survival of patients in stage III2, but not of those in stage III1.
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PMID:Prognostic classification of Hodgkin disease in pathologic stage III, based on anatomic considerations. 86 75

A new treatment program for advanced Hodgkin's disease employing five-drug combination chemotherapy and low dose radiation to the sites of bulk disease (nodal or parenchymal) was designed in 1969. Eighty patients have now been treated, 60 of whom have achieved a complete remission. More significantly, only 5 of the 60 completed responders have relapsed with follow-up from 1-6 years. The cumulative survival at 5 years of patients entering complete remission is 92%. For those patients not sustaining a complete remission, it is 19% at 2 years. This program has resulted in substantially lower relapse rates than previously reported by other investigators, probably because of the administration of radiotherapy in the manner described. Hopefully, a significant number of these patients may be cured of their disease.
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PMID:Long term remissions with combined modality therapy for advanced Hodgkin's disease. 94 2

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.
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PMID:Can pelvic irradiation be omitted in patients with pathologic stages IA and IIA Hodgkin's disease? 94 3


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