Reduced Combined Radiotherapy and Chemotherapy for Hodgkin’s Disease — Risk-Adapted Treatment Approach

Abstract

Over the past two decades major progress has been made in the treatment of Hodgkin’s disease. It may be held as an example of successful tumor therapy. But still today certain subgroups of patients with Hodgkin’s disease do not respond to treatment or relapse early after standard treatment programs. These are particularly patients with advanced disease (stages III B and IV), but also patients in limited stages of Hodgkin’s disease (stages I-III A) with the presence of risk factors. Such risk factors which influence outcome in patients with limited stages of Hodgkin’s disease adversely are:

• Mediastinal bulky disease (diameter greater than one-third of chest diameter) (Prosnitz 1983; Hoppe 1985; Specht and Nissen 1986)

• Extranodal (E) lesions (especially of the lung) (Prosnitz 1983; Rubin et al. 1986)

• Constitutional (B) symptoms (Prosnitz 1983; Rubin et al. 1986; Crnkovich et al. 1986)

• Extended abdominal disease (stage III₂) (Desser et al. 1977; Prosnitz 1983; Mauch et al. 1985; Diehl et al. 1986)

• An unfavorable histological subtype (LD, not classified) (Löffler 1982; Mauch et al. 1985)

Combined modality treatment proved to be very effective in the management of Hodgkin’s disease. However, full-dose radio- and chemotherapy bears an unacceptable risk of long-term complications such as second malignancies [especially acute nonlymphocytic leukemia (ANLL)] and permanent sterility (Coltman and Dickson 1982; Rubin et al. 1986; Bookman and Longo 1983). So it cannot be regarded as the treatment of choice in Hodgkin’s disease (Schmidt 1982).