Karen K. Lindfors

CT appearance of clival chordomas

Computed tomography of 30 patients with chordomas arising from the clivus was reviewed. All examinations demonstrated bone destruction with a soft tissue mass and varying degrees of encroachment on the adjacent brain. Other CT findings included contrast enhancement, soft tissue calcification and well defined areas of low attenuation.

Results of treatment of stage IA and IIA Hodgkin's disease

This study analyzed the 5 year actuarial survival and disease‐free survival of 122 patients with Stage IA and IIA Hodgkins disease, (108 patients laparotomy staged) treated with mantle and paraaortic irradiation from 1975 to 1981. Prognostic subgroups and patterns of treatment failure were investigated. The 5 year actuarial survival and disease‐free survival was 91% and 75% respectively for the entire group. For Stage IA patients, the 5 year survival and disease‐free survival was 92% and 86% respectively, whereas for those in Stage IIA the respective figures were 86% and 65%. Individuals with greater than four sites of involvement at initial presentation; extensive mediastinal adenopathy; hilar or extramediastinal extension to lung, pleura or pericardium, had a poorer 5 year actuarial disease‐free survival (43%–60%) than those without these factors (70%–85%). Of the 122 patients, there were 26 relapses: nine infield failures; two concurrent infield and systemic failures; nine marginal recurrences, and three relapses occuring systemically and three in nodal groups not irradiated. Following relapse, 17 patients were salvaged with chemotherapy. Two patients are alive with disease and seven patients died of Hodgkins disease. Patients with less extensive mediastinal adenopathy and supradiaphragmatic nonmediastinal presentations can be satisfactorily treated with mantle and paraaortic irradiation, whereas patients with extensive mediastinal adenopathy receive six cycles of multiagent chemotherapy before irradiation. Cancer 59:1107‐1111, 1987.

CT demonstration of cardiophrenic angle lymphadenopathy in Hodgkin disease.

Eleven patients with Hodgkin disease involving the cardiophrenic angle lymph nodes are described. Four were discovered at the time of initial staging, and the remainder represented a major site of relapse after therapy. Regression of adenopathy after chemotherapy was documented in six patients; surgical excision (three), biopsy (one) and postmortem examination confirmed the presence of recurrent disease in the remaining cases. Enlargement of cardiophrenic angle nodes was frequently overlooked on conventional chest radiography, but a rather typical appearance is readily identifiable on CT.

Impact of thoracic computed tomography on radiation therapy planning in Hodgkin disease

Over 5 years, CT of the thorax was performed on 53 patients with Hodgkin disease and mediastinal lymphadenopathy prior to the institution of therapeutic irradiation. Information obtained from CT prompted major alterations in the plan of therapy in 11 of 53 (21%) of the patients. These included changes of treatment portal size, the addition of localized boost therapy, and a revision of diagnosis.

Results of treatment of stage 3A Hodgkin's disease

From 1975 to 1981, 38 patients with Stage 3A Hodgkins disease (35 patients pathologically staged) underwent mantle and para‐aortic irradiation, and in 36 patients this was preceded or followed by at least six cycles of multiagent chemotherapy. Both the 5‐year actuarial survival and disease‐free survival for all 38 patients were 83%. There have been six treatment failures: two patients have relapsed within irradiated nodal groups, one patient in apical pericardial lymph nodes as a marginal recurrence, one patient concurrently infield and in unirradiated nodal groups, and two patients systemically (concurrently in unirradiated nodal groups). Of these six relapses, three patients have died of Hodgkins disease, one patient has been salvaged, and two patients currently are under treatment for salvage. One patient has developed acute nonlymphocytic leukemia and died of this disease. Extensive disease, as estimated by the number of sites of involvement at presentation, degree of splenic involvement, extent of intra‐abdominal disease or mediastinal involvement, did not reveal statistically significant prognostic subgroups for relapse. It is currently recommended that patients with Stage 3A Hodgkins disease receive six cycles of multiagent chemotherapy and mantle and para‐aortic irradiation. Cancer 59:27–30, 1987.