The management of XXXX with a large mediastinal mass: a prospective program emphasizing irradiation.

@entity1 @entity978 @entity5 @entity146
Between October 1980 and July 1983, 13 @entity1 with clinical @entity978 who had a large mediastinal mass (mediastinal mass ratio, MMR greater than 1/3) were entered into a prospective treatment program emphasizing irradiation. Careful clinical staging, including CT scanning, was completed in order to define precisely the extent of disease in the chest. All @entity1 had a negative lymphogram. The range of MMR was .34 to .56 (median .39). By the time mantle irradiation was completed the MMR ranged from .21 to .35. One @entity1 had such extensive pulmonary parenchymal extension that treatment with combined modality therapy was necessary. Twelve @entity1 underwent laparotomy after adequate reduction of the mediastinal mass size, but only two had subdiaphragmatic disease detected. One @entity1 had disease extension into the lung during mantle irradiation and one @entity1 failed in a rib six months after completion of irradiation. Both have been treated successfully with salvage chemotherapy. All the remaining @entity1 received prophylactic irradiation below the diaphragm and all are doing well with a median follow up of 21 months. The 2 year actuarial freedom from relapse of the entire group of 13 @entity1 is 83%. These early results are very encouraging for this unfavorable group of @entity1 with large mediastinal masses. This may be due to the routine use of CT scans to determine @entity5 volume and @entity146 mantle irradiation, which often includes prophylactic treatment to the lungs. Careful monitoring of @entity5 response and use of a shrinking field technique has helped to keep complications to a minimum.
