[Current therapy concepts in early and intermediate stages of Hodgkin diseases in adults]

80% or more of patients suffering from Hodgkin's lymphoma (HD) of limited stage are cured with modern treatment. In current scientific studies a controlled and stepwise reduction of the treatment intensity in early stage HD is investigated. Overall survival rate 20 years after treatment is approximately 65%. This figure is approximately between 15 and 20% lower than expected according to the rate of tumor control. This discrepancy is due to an increased incidence of certain other diseases, with an increased incidence of secondary solid malignancies as the main problem. We don't know the relative importance of disease-associated factors, hereditary factors or of treatment-associated factors for this increased incidence of secondary solid malignancies. Irradiation of large volumes is considered an important risk factor. Several retrospective analyses show that the incidence of secondary solid malignancies is significantly lower after limited irradiation compared to large field irradiation. The incidence of secondary solid malignancies after combined treatment with limited field irradiation plus chemotherapy is not higher when compared with chemotherapy alone. After chemotherapy alone this risk is comparable or less than after large field irradiation alone. Finally there is only a small risk of leukemia after treatment with ABVD. An influence of diagnostic laparotomy with splenectomy on the survival of these patients has not been observed. Several retrospective analyses and at least one randomized study with limited chemotherapy, combined with limited irradiation, showed a tumor control rate and an overall survival rate comparable to the figures after more intensive treatment. Based on clinical examinations, patients with CS I and II HD are grouped in low, intermediate and high risk levels.(ABSTRACT TRUNCATED AT 250 WORDS)