Current management and controversies. A surgeon's view.

Abstract

The treatment of early-stage Hodgkin’s disease in adults has now become almost standard. Early-stage Hodgkin’s disease (stages I and II in the Ann Arbor classification) is generally treated by irradiation that extends at least one lymph node group beyond the demonstrable disease (mantle, extended mantle, which includes the periaortic nodes, inverted Y, or total nodal irradiation) [1–4]. The treatment of more extensive disease (stages III and IV in the Ann Arbor classification) remains unsettled, especially in stage III disease where chemotherapy and/or total nodal irradiation have been used. As far as chemotherapy is concerned, MOPP (nitrogen mustard, Oncovin [vincristine], procarbazine and prednisone) [5] is the ‘gold standard,’ although, because of the problems associated with this regimen (notably, sterility in males, the relatively high toxicity, the risk of second neoplasms, and a significant failure rate), other chemotherapy regimens are being studied.