Anatomic Patterns by Histologic Type of Localized Hodgkin's Disease of the Upper Torso*

Abstract

A series of 160 consecutively enrolled patients in a clinical trial of radiotherapy for localized
Hodgkin's disease of the upper torso has been analysed with respect to anatomic patterns of
disease and histologic type. The distribution of 55 patients with stage 1 disease involving a
single nodal region was used to predict distribution patterns for the remaining 105 patients of
more advanced stage.
It was found that deviations from the expected anatomic patterns were more common than
agreements. These deviations often favored a pattern of spread to anatomically adjacent
regions, but this was not true in the case of spread from one side of neck to the other. Rather,
extension to the contralateral neck was seen to depend on functionally contiguous pathways
through mediastinum.
Nodular sclerosing and mixed cell types differed strikingly in patterns of spread, with nodular
sclerosing cases rarely deviating from a pattern of contiguous regional spread. The regions
involved were commonly first mediastinum, then neck, either left or right. In contrast, mixed
cell type disease deviated only in minor ways from spread independent of site of origin. Bila_teral
axillary involvement was predicted to occur rarely on an independent spread basis, but with
mixed cell disease this special anatomic pattern was reported significantly in excess.