Limited Radiation Therapy for Selected Patients With Pathological Stages IA and IIA Hodgkin's Disease

The first definitive reports that early stages Hodgkin's disease (HD) could be cured by radiotherapy were published by Vera Peters in 1950 and by Easson and Russell in 1963. Since then, advances in understanding the natural history, refining the histopathologic classification, and development of a staging system have improved the management of HD. Several studies of early stage HD show greater than 80% actuarial 10- to 15-year freedom from relapse, and less than a 10% mortality from HD after treatment with radiation therapy alone. Radiotherapy has become so successful in the treatment of early stage HD (with combination chemotherapy reserved for relapse) that the risk of dying from other causes approaches the risk of dying from HD itself at 15 to 20 years following treatment. This article outlines the principles of treatment for favorable prognosis clinical stages IA and IIA HD, with emphasis on identifying patients with favorable features who may be treated effectively with mantle irradiation only.