Hilar irradiation in early stage Hodgkin's disease

We conclude that inclusion of the hilar region adds little morbidity, while failure to treat is associated with a finite risk of hilar recurrence. It therefore would seem advisable to include the lung roots in "mantle" field techniques in patients with good pulmonary reserve. Our experience with this group of patients, and with others not included here, suggests that the risk of hilar involvement may be particularly pronounced in patients who present with intradiaphragmatic disease. On the other hand, the relapse rate in the hila is sufficiently small that straight-edged mediastinal fields can be used with relative safety in patients with emphysema or other pre-existing dysfunction for whom inclusion of the additional volume might lead to pulmonary insufficiency.