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Time-Dose Relationship in Hodgkin's Disease

1961; Radiological Society of North America; Volume: 76; Issue: 2 Linguagem: Inglês

10.1148/76.2.276

1527-1315

Ralph M. Scott,

Vascular Tumors and Angiosarcomas

Hodgkin's disease presents the radiotherapist with a variety of clinical pictures ranging from early, apparently localized involvement to disseminated disease which is nearly terminal. The pathologist distinguishes between Hodgkin's paragranuloma, granuloma, and sarcoma. More than one type may be found in the same person, and transition from one to another is not uncommon. Although the peak incidence is in the third decade, the condition may be and frequently is encountered in the young and the old. Associated disease is not unusual. These factors, plus others, make each case an individual problem in management. In some instances a protracted course of therapy with a relatively high total dose seems desirable, while at the other end of the scale a single exposure or, at most, a short course will handle the situation adequately. From this it follows that a guide as to the optimal dose in any overall period of time would be desirable. Time-dose graphs are available for a number of conditions, but a perusal of the literature shows only one such piece of work relating to Hodgkin's disease. Friedman and Pearlman (1), in a paper on mycosis fungoides, published a curve but did not include the data upon which it was based. Du Sault (2) has recently transposed this curve from a linear graph to a straight line on a log-log paper. Such a presentation has come into widespread use since Strandqvist published his classical work on skin cancer in 1944 (3). This study was undertaken in an attempt to construct a graph from the clinical material available in the University of Chicago Radiation Therapy records. Three hundred and four case histories dating back to 1930 were studied and all lesions fulfilling the following criteria were selected to establish the points on the graph: 1. The diagnosis was definitely established by biopsy. Whether the disease process was considered paragranuloma, granuloma, or sarcoma was not taken into account, since often no such distinction was made in the pathological report and in other instances multiple biopsies revealed transitions from one grade to another in the same patient. 2. The patient had received no treatment to the areas under consideration prior to being treated in our clinic. This included chemotherapy and hormonal therapy as well as radiation therapy. 3. The patient did not receive chemotherapy or hormonal therapy during the period of follow-up. This excluded a large number of lesions which otherwise might have been considered successfully treated. 4. The treated lesion showed no clinical evidence of recurrence over a four-year period of follow-up or was not recurrent at postmortem examination. Four years seemed adequate, since our average survival was slightly under three years. Seventy-five lesions meeting these criteria were found. These were then plotted on log-log paper with time in days subsequent to the initial treatment on the x-axis and dose in roentgens on the y-axis.