Hodgkin’s disease is a cancer arising from the lymph nodes. It is often found in older children and young adults. The main treatments for Hodgkin’s disease are radiation therapy and chemotherapy.
If the disease is located in only one or two areas on one side of the diaphragm—that is, either confined to the neck and chest or confined to the abdomen and/or pelvis—the Hodgkin’s disease is considered “early stage.” Patients with early-stage disease are often treated with either radiation therapy alone or 2 or 3 cycles of chemotherapy combined with radiation therapy, with an excellent chance of cure and a low chance of complications.
More advanced Hodgkin’s disease is usually treated with more chemotherapy, and radiation to sites of involvement. Even for advanced-stage or recurrent Hodgkin’s disease, cure is often possible.
In addition to cure, the goal of treatment is to minimize the long-term side effects of the therapy. Most complications are dose-related or related to use of a particular treatment agent. For example, the higher the dose of alkylating agents in a chemotherapy regimen, the greater the risk of infertility or leukemia. The higher the dose of doxorubicin in a chemotherapy regimen, the greater the long-term risk of cardiac damage. Likewise, the risk of all known radiation-related toxicities increases with the dose of radiation. Most significant toxicities from radiation can be avoided by using optimal radiation doses. Proton radiation may be useful to reduce the dose to the heart if the chest is irradiated.
It is very important that patients newly diagnosed with Hodgkin’s disease are evaluated by both a radiation oncologist and a medical oncologist before treatment.
Non-Hodgkin’s lymphomas are classified as low-grade, intermediate-grade, or high-grade and are staged based on the extent of the disease.
Low-grade non-Hodgkin’s lymphomas are often successfully treated with radiation therapy alone if they are limited in extent and do not involve the bone marrow. Even if they involve multiple sites (but not the bone marrow), it may still be possible to completely eradicate the lymphoma with low doses of radiation to wide fields over a large part of the body. Patients who have advanced-stage low-grade non-Hodgkin’s lymphoma that involves the bone marrow are usually followed up until they become symptomatic, then have palliative treatment with chemotherapy or radiotherapy, monoclonal antibodies, or other agents.
Intermediate- and high-grade lymphomas behave more aggressively and are usually treated with chemotherapy followed by radiation treatments to involved areas. involved areas are locations where the tumor can either be seen or felt on physical examination or seen on studies such as bone scans, CT, or MRI. Radiation therapy is an important part of the treatment if the intermediate- or high-grade lymphoma is stage I, stage II, or early stage III. As the stage of disease increases, chemotherapy assumes a more important role in the management plan.