[Hodgkin's lymphoma: problems in the treatment of the early stages]

The prognosis for Hodgkin's disease patients has improved markedly in the past 3 decades, thanks to improved staging techniques and therapeutic advances in both radiation and chemotherapy. Yet, individual treatment schedules continue to evolve: in particular, the extent of irradiation fields, the allocation of Hodgkin's patients to prognostic groups using information from clinical staging techniques and the choice of radiotherapy alone versus combined modalities are still controversial in the early stages of this disease. To try to eliminate the need for staging laparotomy, the EORTC investigated the role of clinical staging in different studies and found that favorable clinical stage I/II patients do not need laparotomy and that irradiation alone yields satisfactory results. Current treatment goals include maximizing the cure rate while minimizing toxicity, late side-effects in particular. An approach is to reduce irradiation fields and combine irradiation with chemotherapy. There is no doubt that various organ sites can be cumulatively damaged by this combined approach, but new protocols seem to yield better results. Several literature findings are reviewed in this paper. The allocation of stage IA and IIA Hodgkin's disease patients to prognostic groups using information from clinical staging procedures appears to be a very important step. The combined approach seems to be useful in patients at intermediate risk of relapse. We conclude that excellent results and very little toxicity and morbidity can be achieved through respect and collaboration between the chemotherapist and the radiotherapist.