Role of radiation therapy in the treatment of Hodgkin's disease.

We reviewed the results of 10 years of experience in treating 105 patients with stage IA-IIIB Hodgkin's disease at the Joint Center for Radiation Therapy. It appears that "total nodal irradiation" may largely be avoided. For supradiaphragmatic stage I and IIA disease, mantle and para-aortic irradiation result in excellent relapse-free survival except in patients with large mediastinal masses. Stage IIB patients can be treated similarly to those in stage IIA. Stage IIIA patients treated with total nodal irradiation alone fare less well. Combined modality treatment improves survival markedly but may cause excessive complications. For stage III1A, we currently recommend that patients be treated with mantle and para-aortic nodal irradiation, with chemotherapy used only in those who fail. We treat stage III2A and IIIB patients with both chemotherapy and radiation.