Cure of early-stage Hodgkin's disease with subtotal nodal irradiation

Article Abstract:

Experience has established that Hodgkin's disease is especially susceptible to radiation, and that radiation alone leads to a high survival rate for early-stage Hodgkin's disease. Over the years, many patients have undergone staging laparotomy, the surgical examination of the abdomen to precisely determine the stage of disease. This has led to great knowledge about the natural history and progression of Hodgkin's disease. However, now that this knowledge has been accumulated, it is unclear that continuing the practice of staging laparotomy provides any benefit to the patient. The staging laparotomy only provides benefit if therapeutic decisions are based on the observations made during the surgery. Since the surgery itself has substantial risks and can result in substantial illness, a review of 94 cases of Hodgkin's disease was conducted to evaluate any potential contribution of staging laparotomy. All 94 patients had Stage I or Stage II disease and were treated with radiation alone. Fifty-two patients underwent a staging laparotomy. All patients achieved an initial complete response, but 10 patients relapsed within 5 years. Overall, the five-year disease-free survival was 86 percent, a rate that compares favorably with other reported survival rates for early-stage Hodgkin's disease. No significant differences were observed between the patients who underwent laparotomy and those who did not. These results indicate that patients with satisfactory clinical indications of early-stage Hodgkin's disease need not be subjected to the discomfort and risks of a staging laparotomy prior to treatment for their disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Tumor staging, Cancer staging

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Night sweats in Hodgkin's disease: a manifestation of preceding minor febrile pulses

Article Abstract:

Although the presence of Hodgkin's disease may be indicated by a number of different symptoms, the triad of fever, sweats, and weight loss, if otherwise unexplained, have proved to be the most robust. Nineteen percent of patients in a previous study complained of sweating without fever; 71 percent of these had clearly nocturnal sweating. Although the cause of this sweating was not determined, one possible cause might be the presence of fever that has gone unrecognized by the patient. To determine if this was in fact the case, the body temperature of six patients was electronically monitored during sleep. Night sweating recurred in four of these patients during the study. In all four cases, an increase in temperature of 0.5 to 1.5 degrees centigrade (approximately 1 to 3 degrees F) was measured no more than 30 minutes prior to sweating. The patients awakened during the sweating, at a point when their body temperatures were already dropping rapidly. The measurements confirm the hypothesis that the sweating is related to a febrile pulse that is not sufficient to affect sleep, but the patient is awakened by the consequent sweating. The precise mechanism of the influence of Hodgkin's lymphoma on the body's temperature regulation is not clear. However, some evidence indicates that stimulated macrophages produce IL-1, which can induce the synthesis of prostaglandin E2 in the preoptic-anterior hypothalamic region of the brain, which seems to alter the proper ''set-point'' for the regulation of body temperature. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Causes of, Physiological aspects, Body temperature, Lymphomas, Fever

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Role of the gallium scan in Hodgkin's disease

Article Abstract:

Gallium 67 is a radioactive isotope of the metallic element gallium. In the chemical form of gallium 67 citrate, it has been found to be a potentially useful tracer for the localization of tumors. The substance becomes preferentially concentrated in tumor cells; the location of the tumor may then be viewed by scintillation cameras and tomographic scanning. However, some investigators have abandoned the test because of the high probability that tumor may be overlooked by a negative gallium scan. In an investigation of the technique's usefulness, 240 scans were performed on 165 patients with Hodgkin's disease. Higher doses were used than on previous studies in an attempt to achieve a higher sensitivity for the technique. The technique showed a high degree of specificity, that is, when the technique yielded positive findings, the patients were very likely to have a tumor. Overall, a specificity of 98 percent was achieved. However, the sensitivity among untreated patients was low, about 64 percent. This means that 36 percent of the patients with tumors went undetected by the method. The sensitivity of the technique was far worse when it was used to screen treated patients for relapses. In routine follow-up scans, 95 percent of the tumors were missed by the gallium scan. While the gallium screening technique may prove to be useful in a confirmatory role at diagnosis, the method is not suitable for routine use in screening. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Isotopes, Gallium, Gallium scan

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