2597

INTRACRANIAL INVOLVEMENT IN HODGKIN’S DISEASE

Akyuz C, Yalcln B, Atahan IL, Kutluk MT, Buyukpamukcu M.

Depts. of Pediatric Oncology and Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Objective: Intracranial involvement by Hodgkin’s disease (HD) is quite rare and usually appears as a late complication in patients with disseminated disease. It is frequently the result of direct extension either from dural and/or osseous deposits or from leptomeningeal metastases. We report three cases of HD with intracranial involvement.

Patients: Among 750 HD patients followed up in our center between 1973 and 2000, intracranial involvement occurred only in three. The ages of the patients were 4, 12 and 15 years (two girls, one boy). Two cases had mixed cellularity and the third had nodular sclerosing type HD. At the time of diagnosis, treatment was planned depending on disease stages as alternating cycles of COPP and/or ABVD chemotherapies and involved field radiotherapy. Following initial diagnosis, intracranial involvement occurred in these three patients in the 26^th, 39^th, and 42^nd months, respectively. Two patients experienced convulsions and the other complained of diplopia prior to the detection of cranial metastases. In these three patients, intracranial lesions were viewed by computerized tomography or magnetic resonance imaging to be located in the left parietal, the left parietooccipital and the right parietal, and the right temporal regions, respectively. Histological verification of cranial involvement of HD was performed in only one case. All three patients were asymptomatic and free of disease following systemic chemotherapy and external radiation therapy to the cranial lesions (3000-4000 cGy). However, they all died with widely disseminated disease 8, 22, and 32 months after the diagnosis of intracranial recurrences, respectively.

Results: Intracranial involvement of HD is usually an indicator of progressive disease. Although intracranial disease responds to radiotherapy and systemic chemotherapy, the ultimate prognosis is poor in these patients despite aggressive treatment.