7.10.2 Radiotherapy

•Curative dose between 35 and 40 Gy without adjuvant chemotherapy, between 15 and 25 Gy combined with chemotherapy

•In patients with unfavorable prognostic factors: instead of involved-field irradiation, extended-field irradiation used above the diaphragm as total nodal irradiation, i.e., mantle-field irradiation, below the diaphragm as “inverse Y” (para-aortic, iliac, and sometimes spleen irradiation)

Favorable prognostic factors in Hodgkin disease

•Low number of involved lymph nodes

•No large tumor burden

•No B-staging

•No extranodal manifestation

•Stages I, II, and IIIA

7.11Prognosis

•Stage I–III: >90% event-free survival

•Stage IV: 70–90% event-free survival

•Unfavorable prognostic factors:

–Mediastinal enlargement

–B-stage: fever, sweating, loss of weight

–Histology: lymphocyte depletion

–Age: a less favorable prognosis for adolescents than for children

7.12Follow-Up Observation

•Observation by clinical and radiological examination, including ultrasounds during the first 4–5 years after diagnosis

•Observation concerning sequelae: thyroid function tests (after irradiation), electrocardiography and echocardiography (after anthracycline treatment), pulmonary function tests (after mantle-field irradiation and/or bleomycin treatment)

•Diagnosis of sexual function and fertility

•Follow-up of psychosocial integration and support

7.13Relapse

•In the majority of patients, relapse occurs within the first 3 years after diagnosis; late relapses in children are rare

•The rate of second remission after combined chemoand radiotherapy is about 80%