Treatment Paradigm

Question 1

Which patients are considered to have early or favorable Hodgkin’s disease and what is the recommended treatment approach?

Answer 1

Favorable disease includes localized disease (stage IA and IIA) involving less than four nodal regions, absence of “B” symptoms, bulk, or extranodal extension. Recommended therapy includes two to four cycles of chemotherapy without alkylators plus low-dose, involved-field irradiation (15-25 Gy). Alternative approaches include six cycles of chemotherapy alone (alternating COPP and ABVD or derivative) or four cycles of chemotherapy alone on trial.

Terezakis, SA, Hudson, MM, Constine, LS. Hodgkin lymphoma. In: Halperin, E, Constine, L, Tarbell, N, et al., eds. Pediatric Radiation Oncology. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:137-165.

Question 2

Which patients are considered to have intermediate-risk Hodgkin’s disease and what is the recommended treatment approach?

Answer 2

Intermediate-risk patients have localized disease involving ≥3 nodal regions in the presence of bulky mediastinal adenopathy (stage IA, IIA, IIB) or stage IIIA disease. (Stage IIB is sometimes classified as high risk.) Recommended therapy includes four to six cycles of chemotherapy and low-dose, involved-field irradiation (15-25 Gy). Alternative approaches include six to eight cycles of chemotherapy alone.

Question 3

Which patients are considered to have unfavorable Hodgkin’s disease and what is the recommended treatment approach?

Answer 3

Unfavorable patients include stage IIB, IIIB, and IV Hodgkin disease. Recommended therapy includes six to eight cycles of advanced chemotherapy with low-dose, involved-field irradiation (15-25 Gy). An alternative approach includes eight cycles of chemotherapy alone.