Patient selection: lymphocyte-predominant Hodgkin's disease, treated with radiation but not chemotherapy
Parameters affecting overall survival:
(1) age of the patient in years at diagnosis
(2) B symptoms (night sweats, fever, unintended weight loss)
(3) number of sites involved
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
< 45 years
|
0
|
|
|
>= 45 years
|
2
|
|
B symptoms
|
absent
|
0
|
|
|
one or more present
|
2
|
|
number of sites involved
|
1 or 2
|
0
|
|
|
3
|
1
|
|
|
4 or more
|
2
|
where:
• The hazard ratio for age >= 45 years was 11.5, for B symptoms 14.4, and for >= 3 sites 5.8 (3 sites) to 10.5 (more than 3 sites)
The risk of progression was increased if there were 3 or more sites involved (hazard ratio 9.3 for 3 sites and 19.4 for 4 or more, Figure 2 page 1225).
The original paper does not use a risk score. One was developed to utilize the data in the paper.
total risk score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the worse the overall survival.
• Radiation therapy can give excellent results with Stage I or Stage II disease with 1-2 sites of involvement. A full mantle field was not needed to ensure freedom from disease progression.
