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doi: 10.1097/01.HS9.0000547874.72351.e2
Early Stages

David J. Straus

Memorial Sloan Kettering Cancer Center, Weill Cornell College of Medicine

Early-stage classical Hodgkin lymphoma (cHL) has been highly curable using extended-field radiation therapy (EFRT) alone, combined-modality therapy (CMT) consisting of chemotherapy and radiation therapy (RT), and more recently, chemotherapy alone. RT either to an extended field (EFRT) or to various iterations of an involved field (IFRT), including involved site RT and involved node RT, is potentially associated with late morbidity and mortality, particularly second primary cancers and cardiovascular complications. Various approaches have been tested to decrease toxicity including reducing the number of chemotherapy cycles, altering chemotherapy regimens to reduce their toxicity and reducing the doses of RT and the size of the treatment fields. Recently, reductions of post-chemotherapy RT fields to residual sites only has been suggested to further decrease off-target tissue and organ exposure. Another approach has been the use of chemotherapy alone, when possible, which can achieve obtain a high cure rate while avoiding RT risks. Although the relapse rate is slightly higher with chemotherapy alone than with CMT, nearly all relapsing patients after chemotherapy alone can be effectively salvaged. Many will not require intensive salvage treatment. Overall survival appears equivalent to CMT with the chemotherapy only approach. The evolution of efforts to minimize toxicity of treatment of limited stage cHL will be briefly reviewed.

Copyright © 2018 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.