With the advent of modern
polychemotherapy and radiation techniques, cure rates in
Hodgkin's disease (HD) have improved substantially. This article summarises current concepts of treatment for early, intermediate and advanced stage HD. Current strategies focus on the balance between cure rate and toxicity. In early stages, cure rates approach 90% and new strategies mainly try to avoid toxicities. Possible approaches comprise the use of less CT or RT or leaving
laparotomy. In advanced stages,
polychemotherapy with 8 courses of either M(C)
OPP or ABVD or M(C)
OPP/ABVD is considered to be the treatment of choice, but unsatisfactory low complete remission rates, progression-free survival or freedom from treatment failure rates have to be improved. The role of additional
radiotherapy after extensive
chemotherapy in the treatment of advanced stages is uncertain. To achieve a better tumour control, new regimens have been developed. The Stanford group initiated the 12-week intensified hybrid protocol Stanford V. The German
Hodgkin's Lymphoma Study Group (GHSG) introduced the
BEACOPP protocol with time intensification and dose escalation of
cyclophosphamide and
etoposide. The Milan
Cancer Institute tries to improve treatment outcome using high doses of single agents. One problem to be addressed in ongoing and future trials is the identification of high-risk groups allowing an early stratification of patients into more aggressive but effective regimens. Risk-adapted
therapy might allow further reduction of doses in patients with early-stage
Hodgkin's disease.