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The H5 study of supradiaphragmatic Hodgkin's disease in clinical stages I-II consisted of two controlled trials adapted to patients considered to have either favorable or unfavorable characteristics, based on prognostic factors identified in two former studies by the European Organization for Research and Treatment of Cancer. Of 494 patients, 257 who were classified as having unfavorable prognosis qualified for the more intensive treatment and consequently were spared a staging laparotomy. They were randomized either to total nodal irradiation (TNI) (132 patients) or to treatment with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) alternated with mantle irradiation (MOPP X 3-mantle irradiation-MOPP X 3; 3M) (125 patients). In complete responders (96%), the 6-year relapse-free survival was 77% in the TNI arm and 91% in the 3M arm (P = .02). Relapses in the initially involved and irradiated mantle area were less frequent in patients started on MOPP. The 6-year actuarial total survival (TS) (TNI, 82%, and 3M, 89%; P = .05) appeared to favor the 3M arm, but this difference disappeared when patients dying from causes unrelated to cancer were excluded from analysis. In men less than or equal to 40 years old, there was no difference in relapse-free survival, freedom from disease progression, or TS between the groups receiving TNI and 3M. Thus, TNI is a short and appealing treatment, especially because it preserves fertility. The same observation was true in women less than or equal to 40 years old. In addition, even irradiation less than TNI, which is meant to spare the ovaries, provided a TS similar to that for 3M.

The interstitial techniques of hyperthermia allow one to obtain a precise specific absorption rate (S.A.R.) in a well-defined volume. We have available a low-frequency prototype amplifier, that is capable of heating up to 6 needles. This device was able to heat small volumes in animals, and then was used for patients. Five superficial tumoral nodules have been treated: the first results seem positive. The next step will be the combination of the techniques of interstitial hyperthermia with brachytherapy.

Three patients with bilateral multiple pulmonary metastases of cylindroma were treated with sequential and repeated courses of chemo- and radiotherapy. Objective symptoms of regression were observed.

Experience gained since 1970 by the study of 1,200 cases in which computerised dosimetry was used has led to the proposition of a reliable and useful method. The results are expressed per 24 hours of exposure in numerical form with regard to reference points, as well as in the form of drawn isodose curves in three different planes of reference: sagittal, frontal oblique by sources and frontal oblique passing by the plane of pelvic lymphatics. The authers recall the definition of reference points: bladder, rectum and pelvic walls. Using three typical examples, the aid provided by dosimetry is described. The concept of a "radiotherapy identity card" as a means of expressing the dose given is discussed. Comparison between dosimetric results and the results of treatment is encouraging in terms of the continued and fore general use of the method.

Techniques of localized hyperthermia have been developed these last years. Very superficial tumors may be heated by infra-red radiation, radiative diathermy at high frequencies (2450 MHz) or even by techniques of contact hyperthermia. Superficial tumors (some cm deep) may be heated by radiative diathermy at lower frequencies (434 MHz or 915 MHz), inductive diathermy or ultrasound. Deeper tumors (about 10 cm deep) are the most problematic. They may be heated by capacitive diathermy at frequencies of 13.5 or 27 MHz under favourable conditions, or perhaps by ultrasound when multiple transducers are used. Hyperthermic extracorporeal perfusion (in limbs) and interstitial hyperthermia are efficient and promising techniques but their indications are limited.

From 1960 to 1984, 871 patients were treated for Hodgkin's disease at the Institut Gustave-Roussy. Twenty-six percent of the cohort were treated with radiotherapy (RT) alone, 6% with chemotherapy (CT) alone, and 68% with a combination of RT and CT, either at first line or for salvage treatment. MOPP chemotherapy was given to 42% of the patients. Overall, 19 secondary acute leukemias or preleukemias were observed, 3 of them after extended RT alone, the other 16 after a combination of RT and MOPP. Among the alkylating agents used, only nitrogen mustard (mechloretamine) was shown in a multivariate analysis to be significantly associated (P less than 0.001) with an increased risk of secondary leukemia. A dose response was observed, with the risk relative to general population incidence rates being 45 in patients having been treated with 1-59 mg (total dose) of nitrogen mustard, 211 in those treated with 60-119 mg, and 636 in those treated with greater than or equal to 120 mg. No other factors were found to be associated with leukemia risk. The 10-year cumulative incidence of leukemia was zero in patients treated with limited RT alone, 2.4% in those treated with extended RT alone, 0% in those treated with a combination of RT and CT without nitrogen mustard, and 12.4% in those treated with RT + nitrogen mustard. Whether other alkylating agents give a similar result remains to be determined; these data suggest that the use of nitrogen mustard at a higher total dose than 60 mg is questionable in the treatment of Hodgkin's disease.

Superficial tumours with a small thickness can be correctly heated by various techniques. Some difficulties arise for a uniform heating across tumours several centimeters thick; they are considerably increased for deep located tumours. The possibilities of various methods of diathermy are discussed with consideration of blood flow and controlled surface cooling. A peculiar attention is devoted to conductive methods using electrodes supplied by 1 MHz current generator, and placed in contact (tubes, plates) or inside (needles) the tumour.

An analysis of the results that have been obtained in several recent controlled clinical trials showed that the inclusion of combination chemotherapy in the initial treatment of Hodgkin's disease significantly improved relapse-free survival but did not improve survival. This is due to the high efficacy of salvage chemotherapy. Paradoxically, the advent of powerful combination chemotherapy makes initial treatment by radiotherapy alone possible in a large proportion of patients with early stages of Hodgkin's disease. Prognostic factors have been identified by a multivariate analysis of the results obtained in the three controlled clinical trials carried out by the EORTC. These factors can help to delineate the subsets of patients who can be treated initially by radiotherapy alone with an acceptable relapse rate and to adjust the size of the radiation fields. The two prominent prognostic factors are: a combination of systemic symptoms and erythrocyte sedimentation rate the number of lymphatic areas involved.

In order to study the possible advantages of thoracic CT scanning in the management of mediastinal lymphomas, a retrospective analysis of 16 patients was carried out. In this group, 21 thoracic CT scans were performed. For 10 patients (and 11 CT scans) we found a discrepancy between the results of "classical" radiology and those of CT scan, the latter giving more information about the precise status of the mediastinum. In 10 cases, we had to modify our treatment, either by adding chemotherapy or changing the radiation field size.