Current strategies for early Hodgkin's disease

A small percentage (approximately < 10%) of patients present with minimal disease that is treatable with only mantle radiotherapy. The vast majority will present with apparent local disease but will have one or another poor prognostic features necessitating staging laparotomy if only mantle/para-aortic radiation therapy is the desired approach. Otherwise, more extensive radiation including splenic fields would be required or combined modality. The unanswered questions include: (1) definition of patients who require no adjunctive radiation therapy; (2) an assessment of the actual quantity of chemotherapy needed if complementary radiation therapy is to be added; and (3) determination of whether 67gallium/SPECT scan can provide a measure of the efficacy of chemotherapy. Finally, can a less toxic regimen be substituted for ABVD in the treatment of early stage disease? Many of these questions are currently under investigation.