Hodgkin disease: prognostic factors and treatment strategies

Depending on stage and risk factor profile, more than 80% of patients with Hodgkin disease (HD) will be cured with modern treatment strategies. In ear ly-stage, favorable HD, extended field irradiation has been the standard tr eatment resulting in cure rates of greater than 90%. However, due to the re cognition of fatal long-term effects, especially the high rates of second s olid tumors, extended field irradiation therapy is now being abandoned by m ost study groups. Instead, mild chemotherapy for control of occult disease is combined with involved field irradiation. In early-stage, unfavorable (i ntermediate) HD, for which combined modality treatment is already the treat ment of choice, extended field irradiation is replaced by involved field ir radiation for the same reasons. A different situation is found in advanced HD. In this case, standard therapy consists of eight cycles of polychemothe rapy. Until recently, modifications of the standard chemotherapy regimens h ad not changed the poor outcome of advanced-stage patients. The development of a new dose-intensified regimen (BEACOPP) now for the first time has sig nificantly improved the prognosis of these patients. Patients who relapse f ollowing radiation therapy alone for early stage HD have satisfactory resul ts with combination chemotherapy and are not considered candidates for high -dose chemotherapy with autologous stem cell transplantation. For patients with relapsed HD after combination chemotherapy, the current data support t he use of high-dose chemotherapy with autologous stem cell transplantation. curl Opin Oncol 2000, 12:403-411 (C) 2000 Lippincott Williams & Wilkins, I nc.