Radiotherapy in the treatment of Hodgkin's disease.

Eighty-seven untreated patients with localised Hodgkin''s disease seen from 1969 to 1975 were treated by megavoltage radiotherapy. All were followed for at least 33 months. Thirty-three patients were staged clinically and 54 underwent more extensive investigation by lapaortomy and splenectomy. The projected five-year disease-free survival figures for patients staged surgically were 100% for the 17 with stage IA disease, 70% for the 19 with stage IIA disease, and 73% for the 15 with stage IIIA disease. These results were consistently better than those obtained in clinically staged patients. Five patients died, one of them without evidence of Hodgkin''s disease. As irradiation seems to produce excellent disease-free survival in most patients who are staged accurately at diagnosis, caution should be exercised in the routine use of adjuvant chemotherapy until the full risks of such treatment are clear. Combined modality therapy may be appropriate for patients with unfavourable features at presentation.     

Early-stage Hodgkin's disease: current approaches to treatment.

Most patients with early-stage Hodgkin''s disease can now be cured by one of several therapeutic approaches. This review highlights the developments in the diagnosis and treatment of the disease that have led to long-term survival rates greater than 90%. Past and present radio-therapy (RT) planning and treatment practices are discussed in the context of both clinical and pathological staging. The role of initial bimodal therapy (RT and chemotherapy [CT]) and the use of CT in patients who suffer relapse after initial treatment with RT alone are reviewed. On the basis of prognostic factors, subgroups of patients for whom bimodal therapy is recommended, including those with a bulky mediastinal mass, have now been identified. Although treatment is highly successful, debilitating consequences of RT and CT, such as infertility, infection and second malignant diseases, remain. Newer treatment regimens may reduce morbidity and have similar or better long-term results with respect to survival and quality of life.     

Hodgkin's disease derived cell lines: a review.

A number of so-called "HD cell lines" have been established over the last 10-15 years (Table 1). Or those 15 cell lines we studied, only the cell lines CO, DEV, HD-70, HDLM, KM-H2, L-428, L-540 and SUP-HD1 can be regarded to represent true HD cell lines. According to the immunostaining results and molecular genetic data, these 8 cell lines can be assigned either to the T-cell lineage (CO, HDLM, L-540) or B-cell lineage (DEV, HD-70, KM-H2, SUP-HD1). With the data currently available, the cell lineage origin of L-428 cannot be unequivocally determined, but appears to be lymphoid. All but one of these eight HD cell lines have been established from patients with the nodular sclerosis subtype. Therefore, the conclusions drawn from the in vitro studies are limited to this histological subtype of HD. It is conceivable that culture conditions select for a particular type of cell that will survive. The state of differentiation of these HD cell lines remains unclear due to the incomplete expression of T- or B-cell antigens. The in vitro cells and the in vivo H-RS cells share, however, the expression of the unique activation markers CD15, CD25, CD30, CD71 and HLA-DR. Recently published data indicate that the HD cell lines express and produce a large number of cytokines. Multiple non-random chromosomal abnormalities and the expression of various proto-oncogenes are also new and exciting findings and certainly deserve further study. In summary, although the cultured cells are not unequivocally proven to be the direct progeny of in vivo H-RS cells, several continuous HD cell lines have been established that display a variety of phenotypical features identical or similar to those of their presumed in vivo counterparts. Surface marker, molecular genetic and other features suggest a T- or B-cell derivation. An extrapolation of these conclusions would point to a lymphoid origin of H-RS cells. Whether H-RS cells can originate from other cell types such as monocytes/macrophages or reticulum cells, cannot be answered with the currently available HD cell lines.     

Successful treatment of meningeal involvement in Hodgkin's disease in a child

Meningeal involvement was diagnosed in a child with IVB degree Hodgkin's disease following three alternatives cures with MVPP/B-DOPA. Irradiation of the skull with alternative intrathecal injections of drugs were applied. The treatment was completed 16 months after the diagnosis of meningeal involvement. No symptoms are observed.