Early, intermediate and advanced Hodgkin's lymphoma: modern treatment strategies

Abstract

Treatment strategies of early stage Hodgkin lymphoma (HL) have changed during recent years. Until recently, extended field (EF) irradiation has been considered the standard treatment. However, due to the recognition of the high relapse rate and the fatal long-term effects, EF radiotherapy (radiation to initially involved and adjacent lymph node areas) is now being abandoned by most study groups. Instead, for favourable early stage disease, short duration chemotherapy for control of occult lesions is combined with involved field irradiation (IF-RT; restricted only to initially involved lymph node areas). Most groups and centres give four courses of adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) followed by IF-RT [30–35 gray (Gy)][1]. Many of the ongoing and recently completed studies were developed in an attempt to reduce the long-term complications of treatment without increasing mortality from HL. These include studies that evaluate reduction of radiation dose or field size; combined modality treatment in an attempt to identify the optimal chemotherapy regimen; the optimal number of cycles of chemotherapy; and to determine the optimal radiation volume and dose when combined with chemotherapy. Table 1 summarizes the most prominent ongoing or recently terminated international trials [2, 3].