The case for chemotherapy only for localized Hodgkin lymphoma

Although radiation therapy (RT) alone, and more recently in combination with chemotherapy, has been the cornerstone of curative treatment for early-stage Hodgkin lymphoma for >40 years, the late toxicities of this treatment are increasingly being recognized as causes of significant late morbidity and mortality. In recent years, the focus of treatment of early-stage Hodgkin lymphoma has been reductions in the doses and fields of RT and attempts to reduce the amount and the toxicity of chemotherapy. Another approach has been to treat with chemotherapy alone and to eliminate RT entirely unless it is absolutely necessary. This review summarizes the accumulating information on the late side effects of treatment of Hodgkin lymphoma, the results of trials with chemotherapy only, attempts to reduce the toxicity of chemotherapy, and the new role of positron emission tomography in treatment planning.