The role of radiation therapy in Hodgkin disease: Experience and controversy. The 54th annual Janeway lecture: 1989

Background. Beginning in 1970, a series of patients with Hodgkin disease were treated at the University of Minnesota, after staging laparotomy, with radiation therapy (RT) for Stage I, II, and IIIA Hodgkin disease. This report is an analysis of the results of the treatment and of treatment modifications. Methods. From 1970 to 1974, all patients were treated with standard RT. In 1975, an analysis of these patients indicated that patients with large mediastinal mass (LMM) and patients with Stage IIIA spleen‐positive (IIIAS+) disease had a higher recurrence rates than patients without these factors. Subsequently, a schema of radical radiation therapy (RRT) was devised, which included low‐dose lung RT for patients with LMM and low‐dose liver RT for patients with IIIAS+ disease. Results. Analysis of the results of the two treatments indicates that the use of low‐dose lung RT in patients with LMM and low‐dose liver RT in patients with IIIAS+ Hodgkin disease produced survival and recurrence‐free survival results equivalent to those achieved by use of combined modality treatment (CMT) or chemotherapy (CT) alone. Conclusions. The use of RT with whole lung and liver irradiation for patients with LMM and IIIAS+ Hodgkin disease, respectively, produces results that are equivalent to those of CMT or CT alone with the advantage of a decreased incidence of second malignant neoplasms. In addition, patients who do not respond to initial RT have a greater chance of being saved with chemotherapy than do patients initially treated with CMT of being saved with RT. The authors suggest that radical RT is the treatment of choice for patients with LMM and/or IIIAS+ Hodgkin disease. Cancer 1992; 70:693–703.