Treatment options depend in large part on a person's age when they are diagnosed, the stage of the disease, whether or not the disease is bulky, and other prognostic factors. This section summarizes the treatment options for adults, based on the stage of cancer.
Some of the differences in therapy for adults and children are discussed in the section, "Hodgkin disease in children." If a teen has achieved full growth, the treatment is usually the same as that for an adult.
Remember that your treatment decision is based on many factors, including:
- The kind of Hodgkin disease you have
- The extent of the Hodgkin disease in your body
- Results of blood and other lab tests
- Your general health
- Your age
- Your medical history
Because of these many factors, your treatment may be a little different from the general outline given below. Regardless of which factors you may have, it is important that your doctors have experience in treating Hodgkin disease.
Stages IA and IIA, favorable
This group includes Hodgkin disease that is only on one side of the diaphragm (above or below) and that doesn't have any unfavorable factors. For example, it is not bulky, it is not in several different lymph node areas, it doesn't cause any of the B symptoms, and it doesn't cause an elevated erythrocyte sedimentation rate (ESR).
The preferred treatment option for most patients is chemotherapy (usually 2 to 4 cycles of the ABVD regimen or 8 weeks of the Stanford V regimen), followed by involved field radiation to the initial site of the disease. A less commonly used option is chemotherapy alone (usually for 4 or 6 cycles) in selected patients.
Doctors often order a PET/CT scan after a few courses of chemotherapy to see how well the treatment is working and to determine how much more treatment (if any) is needed.
In cases where a person can't tolerate chemotherapy because of other health issues, radiation therapy alone may be an option.
For those who don't respond to treatment, high-dose chemotherapy (and possibly radiation) followed by a stem cell transplant may be recommended.
Stages I and II, unfavorable
This group includes Hodgkin disease that is only on one side of the diaphragm (above or below), but that is bulky, is in several different areas, is causing any of the B symptoms, and/or is causing an elevated erythrocyte sedimentation rate (ESR).
Treatment is generally more intense than that for favorable disease. The most common option is chemotherapy (usually ABVD for 4 to 6 cycles or other regimens such as Stanford V for 12 weeks).
PET/CT scans are often done after several cycles of chemotherapy to determine how much more treatment you need. This is often followed by more chemotherapy and/or involved-field radiation therapy to the sites of the tumor.
For those who don't respond to treatment, high-dose chemotherapy (and possibly radiation) followed by a stem cell transplant may be recommended.
Stages III and IV
This includes Hodgkin disease that is both above and below the diaphragm and/or has spread widely through one or more organs outside the lymph system.
Doctors generally treat these stages with chemotherapy at full doses. Although ABVD (for at least 6 cycles) can be used, some doctors favor more intense treatment with the Stanford V regimen for 12 weeks, or even the BEACOPP regimen if there are several unfavorable prognostic factors.
Once again, PET/CT scans might be used during or after chemotherapy to assess how much more treatment you need. Depending on the results of the scans, more chemotherapy and/or radiation therapy may be given.
For those who don't respond to treatment, high-dose chemotherapy (and possibly radiation) followed by a stem cell transplant may be recommended.
Resistant Hodgkin disease
Treatment for Hodgkin disease should remove all traces of the cancer. Once initial treatment is complete, the doctor will probably do further tests to look for any signs of Hodgkin disease, such as PET and CT scans. If the Hodgkin disease is still there, most experts think that more of the same treatment is unlikely to cure the patient.
Sometimes, radiation therapy to a single area of disease that remains after chemotherapy might be curative. Using a different combination of chemotherapy drugs may be another option. If radiation alone was the initial treatment, using chemotherapy (with or without more radiation) might also be curative.
If your cancer has not completely responded to the combination of these treatments, most doctors would recommend high-dose chemotherapy and an autologous stem cell transplant, if possible. If cancer still remains after this, an allogeneic stem cell transplant may be an option.
Another option, either instead of or after a stem cell transplant, may be treatment with the monoclonal antibody brentuximab vedotin (Adcetris).
Recurrent or relapsed Hodgkin disease
Treatment in this situation depends on where the disease comes back, on how long after your initial treatment the disease comes back, and on the treatment you received before the relapse. If the initial treatment was radiation therapy without chemotherapy, chemotherapy is usually given for recurrent disease.
If chemotherapy without radiation therapy was used first, and the cancer comes back only in the lymph nodes, you could receive radiation therapy to the lymph nodes with or without more chemotherapy. Chemotherapy with different drugs may be another option.
Radiation usually cannot be repeated in the same area. If, for example, Hodgkin disease in the chest was treated with radiation and it comes back in the chest, this patient could not be treated with more radiation to the chest. This holds true no matter how long ago the Hodgkin disease was first treated.
Patients whose cancers recur soon after treatment may benefit from more intensive treatment. For example, if the Hodgkin disease has returned within a few months of the original treatment, high-dose chemotherapy with an autologous stem cell transplant may be recommended. On the other hand, if the disease has returned after a longer period, then using the same or different chemotherapy drugs (possibly along with radiation) might also be curative. These are decisions that you and your cancer care team need to make.
If the cancer still remains after an autologous transplant, an allogeneic stem cell transplant may be an option. Another option, either instead of or after a stem cell transplant, may be treatment with the monoclonal antibody brentuximab vedotin (Adcetris).
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