Assessment and Significance of Mediastinal Bulk in Hodgkin's Disease: Comparison Between Computed Tomography and Chest Radiography
- 1 August 1999
- journal article
- clinical trial
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 17 (8), 2493
- https://doi.org/10.1200/jco.1999.17.8.2493
Abstract
PURPOSE: In Hodgkin's disease (HD), mediastinal bulk is currently defined from chest radiograph (CXR) measurements as a ratio of the maximum transverse mass diameter to the internal thoracic diameter at T5/6 level ≥ 0.33. We evaluated how computed tomographic (CT) measurements of bulk correspond to those obtained from the CXR and correlated nodal mass long axis diameter with freedom from progression. METHODS: Ninety-five adult patients who had a CXR thoracic ratio of greater than 0.3 and a CT scan within 28 days of the CXR were included in the study, provided that both investigations were performed before the start of treatment. Measurements of the widest mediastinal diameter and internal thoracic diameter were made on both CXR and CT scan. The thoracic ratio (TR) was calculated for each modality and compared using paired t tests. The longest diameter of the largest individual nodal mass (LIMCT) was also measured from the CT and correlated with freedom from progression using Cox regression. RESULTS: There was excellent correlation between CT and CXR for measurement of TR, with TRCT greater than TRCXR (mean difference of 2%). A TRCT of 0.35 was found to be equivalent to a TRCXR of 0.33. No single measurement of nodal size correlated with the current definition of bulk. However LIMCT greater than 10 cm did correlate with increased risk of progressive HD (P = .03), even after adjustment for other prognostic variables (chemotherapy regimen and Hasenclever Prognostic Index). CONCLUSION: Excellent correlation was observed between assessment of TR by CXR and CT scan. The longest diameter of the LIMCT greater than 10 cm was found to be associated with an increased risk of disease progression.Keywords
This publication has 28 references indexed in Scilit:
- Treatment of advanced-stage massive mediastinal Hodgkin's disease: the case for combined modality treatment.Journal of Clinical Oncology, 1991
- Randomized Trial of Chemotherapy Versus Chemotherapy Plus Radiotherapy for Stage I-II Hodgkin's DiseaseJNCI Journal of the National Cancer Institute, 1988
- Stage IIB Hodgkin's disease: the Stanford experience.Journal of Clinical Oncology, 1986
- The prognostic significance of mediastinal bulk in patients with stage IA-IVB Hodgkin's disease: A report from the Manchester Lymphoma GroupClinical Radiology, 1985
- Large mediastinal mass in Hodgkinʼs diseaseAmerican Journal of Clinical Oncology, 1984
- Importance of initial mediastinal adenopathy in Hodgkin diseaseAmerican Journal of Roentgenology, 1982
- Prognostic significance of mediastinal involvement in Hodgkin's disease treated with curative radiotherapyCancer, 1980
- Further follow-up of results of treatment in 90 laparotomy-negative stage I and II Hodgkin's disease patients: Significance of mediastinal and non-mediastinal presentationsInternational Journal of Radiation Oncology*Biology*Physics, 1980
- Radiographic features of recurrent intrathoracic Hodgkin's disease following radiation therapyAmerican Journal of Roentgenology, 1979
- The significance of mediastinal involvement in early stage Hodgkin's diseaseCancer, 1978