Current Issues in the Management of Patients with Hodgkin’s Disease

Abstract

There is currently great and often heated debate over some important aspects of the management of patients with Hodgkin’s disease. New data concerning the proper staging of patients have been developed at several centers, but these data and their implications for staging and management have not been universally accepted. Research at several institutions has indicated that a combined modality approach to some patients with early stage disease offers the best chance of prolonged disease free survival. However, some investigators have argued that overall survival is not enhanced by such aggressive treatment because “salvage” chemotherapy will cure a significant fraction of radiation failures. “Salvage” therapy, however, has not been so effective in all studies. Those who favor the radiotherapy alone approach to all patients with early stage disease argue additionally that the frequency of second malignancies in patients with Hodgkin’s disease is greatest in patients who receive intensive combined modality therapy. Others point out that, while this may be true, closer examination of relevant data demonstrates that the incidence of second malignancies is greatest in patients who receive intensive radiotherapy initially, relapse, and then receive intensive combination chemotherapy as reinduction treatment. It must be noted that such reinduction chemotherapy constitutes “salvage” therapy.