Treatment strategies for Hodgkin's disease

Over the past 2 decades, treatment of Hodgkin's disease has evolved considerably through innovations in the management of various stages. The impact of various treatments on the 5-, 10-, and 15-year results is being balanced against delayed morbidity, such as organ damage and second malignancies, produced by the intensity of therapy or the prolonged delivery of given drugs. The results of clinical trials performed during the past decade have allowed us to reconsider the various prognostic variables that can be used in the treatment strategy. The major unfavorable prognostic factors are represented by bulky disease, multiple extranodal sites, systemic B symptoms, age greater than 60 years, lymphocyte-depleted histology, male sex, and progressive disease during chemotherapy. In patients with early disease after surgical staging, the aim of current therapy is to provide a high cure rate within a short period and with limited morbidity. In patients with advanced Hodgkin's disease, the treatment strategy is to achieve durable complete remission in most cases through effective, full-dose, multidrug regimens at the expense of acceptable morbidity. Subtotal or total nodal radiotherapy (RT) induces a 10-year cure rate ranging from 70% to 85% in stages I and II with no bulky lymphoma. In patients with bulky disease and all three systemic symptoms, comparable results can be achieved with primary chemotherapy followed by RT. Currently, stages IIIA and IIIB disease are often managed with combined treatment modalities, although comparable results can be obtained with intensive chemotherapy alone.(ABSTRACT TRUNCATED AT 250 WORDS)