Combined chemotherapy and radiotherapy for Hodgkin's disease

This paper reviews the treatment of advanced and intermediate stage Hodgkin's disease with combination chemotherapy alone and combined chemotherapy and radiation. Relapse following complete remission with chemotherapy occurs principally at initial sites of disease; its occurrence will be reduced by radiotherapy to those sites. There is disagreement regarding the frequency of relapse and hence the impact of consolidation radiotherapy. Our interpretation of the literature is that relapse occurs in approximately 25% to 50% of all patients achieving complete response with chemotherapy, and that consolidation radiation reduces relapse frequency with a resultant increase in survival. The addition of low dose, involved field radiotherapy is generally free of significant adverse effects. In particular, there appears to be no increase in second malignant neoplasms. The risk: benefit ratio for adding radiotherapy to chemotherapy in patients with advanced Hodgkin's disease is, therefore, quite favorable. We believe that combined modality therapy should become the standard treatment.