The treatment the doctor recommends depends in large part on the patient's age when they are diagnosed, the stage of the disease, whether or not the disease is "bulky," and other prognostic factors. For an adolescent who has achieved full growth, the treatment is usually the same as that for an adult. This section summarizes the treatment options based on the stage of cancer and points out some differences in therapy for adults and children.

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 doctor 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 doesn't cause any of the B symptoms, and is not in several different lymph node areas.

The preferred treatment option for most patients is chemotherapy (usually 2 to 4 cycles of the ABVD 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.

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, and/or is causing any of the B symptoms.

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). 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 of 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 or BEACOPP regimen. 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 is still there 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. But 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.

Recurrent or relapsed Hodgkin disease

Treatment in this situation depends both on where the disease comes back and on the treatment that 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 came 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.

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 long period, then using different chemotherapy drugs might also be curative. These are decisions that need to be made by you and your cancer care team.

Last Medical Review: 07/21/2009
Last Revised: 07/21/2009