Hodgkin's disease. Treatment of intermediate stages

Intermediate stage Hodgkin's disease (HD) is defined as nodal disease with certain clinical risk factors. Patients with intermediate stage HD qualify for a combination of chemo- and radiotherapy, since radiotherapy alone results in a high relapse rate. The precise definition of this group varies between trial groups. It is generally believed that such patients should receive 4-6 cycles of modern multidrug chemotherapy and in addition radiotherapy of the involved field or the extended field. With modern combination therapy, about 70-80% of the patients in this group can be cured. However, the combination of the number of chemotherapy cycles, the field sizes and the dosage of radiation within these fields are not clear. Current clinical studies try to reduce radiation dose and field without compromising treatment efficacy in order to reduce late toxicities.