To lap or not to lap

Experience at various institutions has shown staging laparotomy to be an important procedure to define a subset of patients who may be treated with radiation therapy alone. Available clinical tests without staging laparotomy understage patients in approximately one-third of the time. Since the majority of pathologic stage III patients are probably best treated with combination chemotherapy, initial treatment with radiation therapy without staging laparotomy may be suboptimal. The patients with clinical stage I and II Hodgkin's disease who present for therapy should be treated with a regimen that maximizes the chances for cure the first time around. The group of patients which fails initial radiation therapy after clinical staging may experience toxicities of both full-dose radiation therapy and salvage chemotherapy without survival benefit. Staging laparotomy has acceptable morbidity, and it continues to provide crucial data for effective treatment planning.