Treatment approaches in early stage Hodgkin’s lymphoma

Combined modality treatment (CMT) with radiation therapy (RT) and chemotherapy has largely replaced RT alone for the treatment of early stage Hodgkin lymphoma. 1-3 A major concern remains the late toxicities of treatment most of which are attributable to the RT, although recent CMT regimens have reduced the size of the RT portals and the doses of RT in an attempt to reduce toxicity. Recently several studies have suggested that chemotherapy alone is a reasonable treatment option for patients with early stage non-bulky Hodgkin lymphoma. Combined modality treatment remains the standard treatment for early stage HL with bulky disease (mediastinal mass >1/3rd the thoracic diameter or peripheral nodal mass >10 cm), since RT to regions of tumor bulk in combination with chemotherapy has been demonstrated to reduce the risk of recurrence.4,5 Positron emission tomography (PET) may eventually define a subgroup of patients with early stage bulky disease who can be followed without additional RT after chemotherapy.6