Controversies in early-stage Hodgkin's disease

Early-stage Hodgkin's disease accounts for approximately 60% of all cases of the illness. Because of its excellent cure rate (80% to 90%) and high salvage rate, it is difficult to demonstrate survival advantages for different management options. Currently, there is no consensus as to the optimal staging and treatment strategy for early-stage Hodgkin's disease. With the increasing recognition of the late consequences of Hodgkin's disease therapy, the focus of recent clinical trials has been on exploring treatment modifications to reduce these late effects. Areas of controversy that are being explored include extent of staging work-up, radiation field size and dose (and as part of combined-modality therapy), optimal chemotherapy regimen, number of cycles of chemotherapy, and limited- vs extended-field radiation therapy and dose. In addition, several studies are investigating the feasibility of chemotherapy alone in early-stage patients. Along with the evaluation of modified treatments, long-term follow-up efforts should continue in patients who are cured in order to confirm the long-term safety of such therapies.