The treatment of non-Hodgkin's lymphoma

Much of the approach to evaluation and management of the non-Hodgkin's lymphomas has been modeled after Hodgkin's disease. However, as the name implies, they are quite different. The non-Hodgkin's lymphomas are a group of diseases and syndromes. These many different presentations, syndromes, and possibly different diseases must be distinguished and separated in order to evaluate results. Advances in pathologic classification attempting to relate the disease to physiological activities of lymphocytes are being made, but a simple, clinically relevant scheme is not available at present. We recognize large differences in nodular vs. diffuse histologic patterns. Non-Hodgkin's lymphoma is only infrequently restricted to a single anatomical area, but when it is, radiation therapy can result in a significant proportion of cures. More widespread disease requires systemic therapy. Most encouraging results are found with whole-body radiation used as a systemic agent with the use of multidrug combination chemotherapy. Perhaps whole-body radiation will be most useful when combined with combination chemotherapy as systemic therapy for some groups of non-Hodgkin's lymphoma.