Hodgkin's Disease - Treatment Options by Stage

Radiation Therapy

Radiation therapy, which shrinks tumors, has been used to treat Hodgkin's disease for more than 50 years . High-dose radiation is generally reserved for adults. Radiation treatments are very toxic for children and appear to add little benefit. In young patients, radiation is mostly used if there are large areas of disease in the chest; otherwise, chemotherapy, which may be combined with low-dose radiation, is the best option and produces excellent survival rates.

Radiation Treatment Approaches

The two main types of radiation therapy used for Hodgkin's disease are extended field radiation and involved field radiation.

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Extended field radiation targets the diseased lymph nodes and surrounding healthy lymph nodes. Extended-field radiation is rarely given in combination with chemotherapy. Specific subtypes of extended field radiation are used depending on the location of the disease:

• If HD is above the diaphragm, “extended field radiation” is delivered to the neck, chest, and under arms (called the mantle field). Radiation is sometimes expanded to include lymph nodes in the upper abdomen.
• If cancer is below the diaphragm, an "inverted Y" field is sometimes used, in which radiation is directed at lymph nodes in the upper abdomen, spleen, and pelvis.
• Inverted Y-field radiation therapy combined with mantle-field radiation is called total nodal radiation.

Involved field radiation targets only lymph node regions that are known to have cancer, not the adjacent, uninvolved lymph node regions. Involved-field radiation is usually given after several rounds of chemotherapy.

In general, recent research suggests that extended-field radiation adds little survival advantage and carries a greater risk of serious side effects. Involved-field radiation is now becoming the preferred method. In recent studies, a lower-dose involved-field radiation, combined with chemotherapy, helped achieve good outcomes for patients with early-stage Hodgkin’s disease who had a favorable prognosis. More research is needed before standard practice guidelines can be implemented.