Treatment by Stage of Hodgkin's Disease
Early-stage HD Treatment
If Hodgkin's disease (HD) is in its early stages and disease is contained above the diaphragm, the large abdominal muscle that controls breathing, radiation therapy typically has been the treatment of choice. External beam radiation (delivered outside of the body by a machine) usually is aimed at the mantle field - the neck, chest, and lymph nodes under the arms. Occasionally, the patient's condition calls for total nodal irradiation - that is, radiation is directed at the nodes in the upper abdomen, lower pelvis, and the spleen.
In general, the radiation dose depends upon the stage of HD. However, if early stage cancer is found below the diaphragm, treatment may involve chemotherapy, with or without radiation therapy.
Late-stage HD Treatment
Late-stage HD (e.g., Stage 3) in adults who do not have much involvement of the chest may be managed by total nodal irradiation, with/without liver irradiation, or chemotherapy, with/without radiation therapy to areas of bulky disease.
Widespread HD Treatment
Adults with more extensive HD (e.g., Stage 4) often will be treated with chemotherapy alone or in combination with total nodal irradiation or radiation to areas of bulky disease, or bone marrow transplantation.
Recurrent HD Treatment
If the patient experiences a relapse (the disease comes back), treatment is determined by two things: (1) the previous form of therapy, and (2) the new location of disease. If the patient was first treated with radiation therapy, usually appearing within 2 years of treatment, then chemotherapy usually is given.
Adults who were first treated with chemotherapy usually will receive radiation therapy to the lymph nodes with/without more chemotherapy. HD recurrence at more that one site may warrant higher doses of chemotherapy and consideration of bone marrow transplantation.