Combination chemotherapy in Hodgkin's disease: relation to radiotherapy

The results of modern radiotherapy for Hodgkin's disease are correlated to the stage of the disease. Five-year disease-free survival for pathologically staged patients can be estimated as follows: PS I & II A...90%, PS III A & IIIsA...60%, PS I & II B ...75%, PS III B & IIIsB ...40%. Combination chemotherapy of the MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) type can be successfully employed for patients who develop recurrent disease after total lymphoid irradiation. There have been several randomized clinical trials attempting to improve the curative potential of radiotherapy by combining modern chemotherapy with the irradiation as an adjuvant. The tolerance of patients to total lymphoid irradiation and chemotherapy will be presented. The Stanford trial, initiated 5 years ago (1968), has demonstrated prolonged disease free survival when both forms of treatment are used initially in certain stages of the disease. However, actual survival has not yet improved, probably because the chemotherapy is successful in inducing durable remissions for patients who recur after irradiation.