[Radiotherapy of lymphogranulomatosis in adulthood]

Hodgkin's disease is a highly curable disease. In clinical stages I to II (A and B) of Hodgkin's disease radiotherapy alone is curative in more than 80% of the patients. Challenges remain, however, to further refine our therapy, identify and cure the minority of patients who continue to succumb to this disease. Innovative therapies or significant modifications of current standard therapies are very much needed. The sequential approach of drugs and radiation therapy could reduce the length (not the dose!) of primary chemotherapy as well as the extent and the dose of additive radiation. An effective polydrug regimen not including alkylating agents may avoid the risk of infertility and second malignancies. In patients with Hodgkin's disease presenting with massive mediastinal involvement the efficacy of combined modality therapy has been proven by all research groups. In patients with clinical stage III (A and B) as well as selected stage IV Hodgkin's disease the percentage of nodal relapse is not negligible even after a very effective chemotherapy. Radiotherapy limited to the initial site(s) of bulky lymphoma is not enough to avoid the risk of nodal relapse in adjacent nodal areas. And here, too, avoiding the administration of alkylating agents may drastically reduce some of the serious long-term toxicities.