Treatment of Hodgkin's disease:: Current strategies of the German Hodgkin's Lymphoma Study Group

At present over 90% of early stage Hodgkin's disease patients will be cured. Both radiotherapy and combination chemotherapy are effective treatment modalities. However, the optimal choice of treatment or combinations of treatment is still debated. Recently, several trials reported excellent treatment results with combined modality in early stages of Hodgkin's disease. The use of chemotherapy regimen not including alkylating agents may avoid the risk of infertility and secondary malignancies and facilitates reduction of dose and field size of radiotherapy in early stages. In intermediate stages new chemotherapy regimen (i.e., BEACOPP) will offer the chance to reduce the fraction of patients with initial treatment failure, while reducing the extent of radiotherapy. With the introduction of the escalated BEACOPP regimen it was demonstrated that the prognosis of the advanced stages could be positively influenced by intensification of therapy. Future trials aim to answer: 1) which chemotherapy regimen in which quantity will be the best with respect to efficacy and longterm toxicity and 2) which dose and field size of radiotherapy is adequate within the combined modality approach.