Recent advances and controversies in the management of Hodgkin's disease.

Sifting the preceding factors, which may weigh for or against routine laparotomy and splenectomy as a staging procedure in Hodgkin's disease, we advocate that one be sure the diagnosis and histologic classification are confirmed by an experienced hematologic pathologist, that complete clinical studies for clinical staging with the exception of the lymphangiogram be performed, and that a laparotomy and splenectomy be performed in appropriate centers for clinical Stages I through III and unconfirmed Stage IV patients unless some contraindication is present. The subdiaphragmatic nodal areas should not be irradiated without evidence of the presence of disease in these areas. A minimum of 4,000 rads of supervoltage therapy should be delivered to the areas known to be involved with Hodgkin's disease plus the neighboring lymph node areas, using total nodal irradiation only on definite indication but not prophylactically.