M.G. Papi

Merkel cell carcinoma and iodine-131 metaiodobenzylguanidine scan

Two cases of Merkel cell carcinoma, a neuroendocrine neoplasia of the skin, investigated with iodine-131 metaiodobenzylguanidine (131i-mIBG) scintigraphy, are reported. Uptake in the tumor was evident only in 1 case. The possible diagnostic and therapeutic role of 131I-mIBG in patients with this rare neoplasm is discussed.

64 O - Second malignant neoplasms after hodgkin's disease (HD): an analysis of 1531 patients (PTS) treated in florence (1960–1991)

Purpose To define the risk of having a second malignant neoplasm (ST) in different subsets of HD patients, therefore possibly identifying clinico-therapeutic factors linked with an increased second tumor probability. Methods and materials Cumulative probability of having a ST has been calculated for the different clinical and therapeutic subgroups of a population of 1531 patients consecutively treated (1960–1991) for HD at the Florence Radiotherapy and Hematology Departments. Clinical stages (CS) at diagnosis were distributed as follows: CS I, 13%, CS II, 48%, CS III 30%. CS IV 9%, Initial treatment consisted of radiation alone (52%), combined modality treatment (21%), chemotherapy alone (27%). Incidence data in the different clinico-therapeutic subgroups of this series have been compared with multivariate analysis (Cox model). A comparison has been also made with the general population, deriving observed/expected ratios for the different tumor types. For selected tumor types, a “nested” case-control study is ongoing. Results An increased ST risk has been observed in patients older at HD diagnosis. The same trend was observed for second solid tumors (SST). However, the incidence of ST rises strikingly after very long follow up intervals, so that it is desirable to follow up indefinitely the cohorts of pts younger at HD diagnosis. Acute leukemia was more frequent in patients initially given chemotherapy, alone or associated with radiotherapy, while the relationships between SST occurrence and the treatment given are less evident.

66 P - Twenty years’ experience with hodgkin's disease (HD) at the university of florence: the remaining challenge after a “success story”

Purpose During the last twenty to thirty years remarkable gains in survival of HD patients (pts) have been achieved. The two main goals actually pursued by all the major Centers are a reduction of the toxicity of the treatment for the majority of the pts with better prognosis and the adoption of a more aggressive clinical behaviour in the minority with an “high risk” of relapse and/or death. We therefore reanalyzed the series of the Radiotherapy (RT) and Hematology (HE) Departments of the Florence University (UF). that bave worked togheter in the management of HD in the last two decades, aiming at a better definition of the prognostic value of the different clinicopathologic factors and to evaluate treatment results in the different subsets of pts. Materials and methods From 1960 to 1991. 1531 pts have beeen treated with radical aim. Half of them have been submitted to staging laparotomy with splenectomy. The main features of the series are as follows: Clinical Stage (CS) I. 13%; II, 48%, III. 30%, IV, 9%; General symptoms: A,68%, 8,32%; Histology: LP.12%; NS.43%. MC.40%. LD.5%; Treatment at presentation: RT alone. 52%; Chemotherapy alone, 27%; Combined modality, 21%. Differences in survival rates among the different subsets of patients or according to the treatment given have been analyzed with uni·-and multivariate analysis (Cox model); the same was done for the incidence of the main types of jatrogenic damage. Results Actuarial 10-year disease specific survival for the whole series ranged 86% (CS I pts) to 43% (CS IV pts). A detailed analysis of survival and toxicity results in the different subsets of pts will be presented.

65 P - The prognostic relevance of the substages of pathological stage III hodgkin's disease (HD) and its clinico-therapeutic implications

Owing to the good results obtained nowadays with the treatment of HD, a large number of long term survivors may be studied to better define “high risk” and “low risk” cases, to tailor treatment at presentation according to the available prognostic factors. Large series coming from single, Institutions include patients (pts) treated according to a more homogeneous clinical behaviour and the resulting data analysis is therefore more accurate. The Radiotherapy (RT) and Hematology (HE) Departments of the University of Florence (UF) walked togheter in the management of HD during the last 20 years and decided to pool togheter their clinical material for analysis. This report analyzes the effect of the different prognostic factors and of the therapeutic options adopted at presentation on survival (actuarial uncorrected, corrected and relapse free) and on the incidence of jatrogenic damage, for the stage III cases staged with laparotomy and splenectomy (pathologic stage, PS). In particular. the prognostic impact of the anatomic substaging (III I and III2 substages) of these patients will be analyzed. Between 1970 and 1991. 1261 pts have been treated at the UF. Of them, 219 have been staged as PS III cases. The main clinico-therapeutic features of this subgroup are as follow: Gender: M 138. F 81; Age: 50 yrs= 35; Clin. Stage: I = 10; II = 97; 111 = 112; Path. Stage:III1= 126; III2= 93 Systemic symptoms: A = 154; B = 65; Histology: LP - 22; NS = 83; MC = 101; DL = 8; No subtype = 5; Treatment at presentation: IIIl pts: RT=67; RT+CHT=26; CHT=26; III2 pts: RT: 24; RT+CHT=38; CHT=31. Among the 219 cases treated we observed 100 relapses; 49 patients deceased because of Hodgkins disease, 51 have been salvaged with second line treatment.

795 Early stage Hodgkin's disease (HD): An analysis of prognostic factors in a large series from a single institution

Considerable progresses have been made in the treatment of HD in the last 25 years: cause specific survival rate for HD patients (pts) treated in Florence (all stages combined) is much higher for those treated after 1970 then in those treated before (74% vs 46% at 20 years). Results are even better for early stage HD. However, the analysis of prognostic factors in early stage HD is crucial to the definition of “high risk” groups, to be treated more aggressively, and of “low risk” subsets of patients, for whom the “therapeutic burden” could be reduced, to avoid long term sequelae. We present the results of an analysis on 841 Clinical Stage I–II HD pts (472 of whom have been submitted to staging laparotomy) consecutively treated 1960 through 1991, at the Florence Radiotherapy Department. Data from a single Institution are more homogeneous; moreover, our cases have been submitted to unlimited follow up and long term results have therefore a sound basis. Twenty-years cause specific survival rates are higher in patients: without “B” symptoms (77% vs 59%); with favourable histology (PL, NS); in the younger ones; in the females (78% vs 70%); in patients with CS I (84% vs 71%); in patients without lung hilar involvement (76% vs 65%); in patients presenting with high neck or subdiaphragmatic involvement only. Conversely, bulky mediastinal disease does not seem to adversely affect prognosis. The use of more aggressive treatment options (including chemotherapy) seems to ameliorate prognosis in patients with “B” symptoms. Results of uni- and multivariate analysis of the different factors affecting cause specific and relapse free survival will be discussed.