Treatment of Hodgkin's disease: results and current concepts of the German Hodgkin's Lymphoma Study Group

Abstract

Background: Treatment strategies in Hodgkin's disease (HD) are changing fundamentally over the last decades. Both radiotherapy and combination chemotherapy are effective treatment modalities. However, the optimal choice of treatment or combinations of treatment is still debated for different prognostic groups.

Patients and methods: The German Hodgkin's Lymphoma Study Group (GHSG) initiated randomized clinical trials since 1978. Over the past 20 years, more than 6000 patients with HD in all stages were randomized, treated and followed by the GHSG. Patients are now being recruited from more than 300 clinical centers.

Results: As a consequence of different clinical trials, it is now the policy of the GHSG to tailor treatment to the individual risk of patients, giving favorable patients less intensive and less toxic therapy than unfavorable patients. The treatment for early and intermediate stage HD becomes quite similar with few cycles of polychemotherapy followed by involved field irradiation. In advanced stage HD, the introduction of dose intensified chemotherapy (BEACOPP), has improved treatment results and thus will substitute the MOPP or ABVD regimens.

Conclusions: Although most of the patients with HD will be cured by modern treatment strategies, several questions are still subjects of ongoing clinical trials: 1) which chemotherapy regimen in which quantity will be the best with respect to efficacy and toxicity and 2) which dose and field size of radiotherapy is adequate within the combined modality.