Complications of total nodal irradiation of Hodgkin's disease stages III and IV.

One hundred twenty-seven patients with Hodgkin's disease, Stages III-IV, received total nodal irradiation. Of these, 101 patients were managed primarily by radiation therapy employing the split course sequential segmental radiation technique called the "3 & 2". A dose of 3800-4000 rad is delivered in 2 phases in an overall period of 12 to 13 weeks (TDF 61-64; 1094-1148 rets). For various reasons, the remaining 26 patients received their mantle irradiation to full doses 3800-4000 rad in 4 weeks (TDF 63-66; 1112-1184 rets) without rest periods and a few were irradiated after failing chemotherapy. Of the 101 patients treated between 1969-1974 using the "3 & 2" technique, 2 developed pericarditis (2.0%), none manifested symptomatic pneumonitis (0%), and 3 hypothyroidism )3.0%). The low incidence of severe complications is primarily the result of the technique employed to give total nodal irradiation. The overall incidence of Herpes Zoster was 42% (53/127), and there was a slightly higher incidence when TNI was given following splenectomy.