[Hodgkin lymphoma].
In the newly published WHO classification for tumors of the hematopoietic and lymphoid tissues, Hodgkin's disease has been renamed Hodgkin lymphoma, which reflects the recent confirmation of its germinal center B-cell origin. In the classification, nodular lymphocyte-predominant Hodgkin lymphoma has been added as a new entity with an excellent prognosis. For management of the disease, a risk-adapted classification is employed without staging laparotomy. In limited stages without risk factors, subtotal nodal irradiation with sophisticated techniques can cure more than 80% of patients. Multimodality therapy with chemo- plus radiotherapy can improve disease-free survival, but overall survival remains unchanged. In the intermediate stages with risk factors, chemo- plus radiotherapy is standard, with 3-4 cycles of ABVD and involved field irradiation. In advanced stages, chemotherapy plays a decisive role, with radiation therapy used as an adjuvant for bulky and/or slowly responding tumors. Long-term follow-up of cured Hodgkin patients has revealed increased incidences of solid malignancies and ischemic heart disease more than 15 years after therapy. Breast cancer and ischemic heart disease appear to be related to mantle irradiation, although sophisticated modern radiation therapy techniques are demonstrated to lower the incidence of these long-term morbidities. Meticulous radiation therapy remains the most effective tool for local control of Hodgkin lymphoma.
Itami
Jun
J
D019317:Evidence-Based Medicine; D006689:Hodgkin Disease / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009367:Neoplasm Staging