Hodgkin’s disease, also known as Hodgkin lymphoma, is a highly curable cancer of the lymphatic system.

For patients diagnosed with early stage disease (stage I or II), a combined approach using chemotherapy plus involved field radiation therapy (IFRT) has become a standard of care. This method balances the effectiveness of chemotherapy in eradicating systemic disease with the localized benefits of radiation to ensure durable remission and excellent long-term survival.

Understanding Early Stage Hodgkin’s Disease

Early stage Hodgkin’s disease is typically defined as:



  • Stage I: Involvement of a single lymph node region or a single extralymphatic site




  • Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm



Patients may also be categorized as favorable or unfavorable based on factors such as:



  • Large mediastinal mass




  • Elevated erythrocyte sedimentation rate (ESR)




  • Involvement of multiple nodal regions




  • Presence of B symptoms (fever, night sweats, weight loss)



These risk factors help guide treatment intensity and duration.

The Role of Chemotherapy

The most widely used chemotherapy regimen for Hodgkin’s disease is ABVD, which includes:



  • Adriamycin (doxorubicin)




  • Bleomycin




  • Vinblastine




  • Dacarbazine



ABVD is typically administered every two weeks for 2 to 4 cycles, depending on disease stage and response. Chemotherapy is effective at treating both visible and microscopic disease and forms the backbone of most Hodgkin’s treatment protocols.

Involved Field Radiation Therapy (IFRT)

Involved Field Radiation Therapy (IFRT) targets only the areas initially involved with lymphoma, rather than treating the entire lymphatic system. This precise approach minimizes damage to healthy tissues while eliminating residual cancer cells after chemotherapy.

Radiation is generally administered after chemotherapy at doses of 20–30 Gy, depending on risk category and tumor burden. Treatment typically lasts two to four weeks and is delivered on an outpatient basis.

Why Combine Chemotherapy with Radiation?

Clinical trials have demonstrated that combined modality therapy (CMT) — chemotherapy followed by IFRT — results in:



  • Higher complete remission rates




  • Improved progression-free survival




  • Lower relapse risk, especially in bulky disease




  • Reduced long-term toxicity, compared to extended radiation alone



This combination is particularly beneficial for patients with bulky disease or partial response to chemotherapy. In favorable early-stage patients who achieve a complete metabolic response on PET scan after chemotherapy, radiation may sometimes be omitted based on recent study protocols.

PET-Adapted Treatment Strategies

The use of PET (positron emission tomography) scans after initial chemotherapy cycles has become a valuable tool in guiding further treatment. Patients who achieve a complete metabolic response may be spared radiation, reducing long-term risks of secondary cancers and cardiovascular complications.

PET-adapted strategies include:



  • Reducing chemotherapy cycles in good responders




  • Omitting radiation in patients with negative interim PET scans




  • Escalating treatment in poor responders



This personalized approach aims to balance efficacy and toxicity.

Outcomes and Cure Rates

Early stage Hodgkin’s disease treated with chemotherapy and IFRT has an excellent prognosis:



  • 5-year overall survival: 90–95%




  • Progression-free survival: 85–90%




  • Cure is often achieved with front-line therapy



Long-term studies continue to monitor survivors for potential late effects such as:



  • Secondary malignancies (e.g., breast or thyroid cancer)




  • Cardiopulmonary toxicity




  • Fertility issues



Ongoing research focuses on reducing exposure to harmful agents without compromising cure rates.

Reducing Long-Term Side Effects

Modern radiation techniques and risk-adapted chemotherapy have significantly reduced treatment-related toxicity. Current strategies include:



  • Using involved site radiation therapy (ISRT) to limit fields even further




  • Omitting bleomycin in select patients to reduce lung toxicity




  • Limiting the number of ABVD cycles in favorable-risk patients



Patients are closely monitored during and after treatment to ensure early detection of any adverse effects.

Conclusion

Chemotherapy plus involved field radiation remains a cornerstone in the treatment of early stage Hodgkin’s disease. This proven, effective strategy offers high cure rates with manageable side effects when delivered by an experienced care team. With advances in imaging and tailored treatment protocols, many patients can now achieve remission with fewer long-term health risks.

If you or a loved one has been diagnosed with early stage Hodgkin’s lymphoma, discussing combined modality treatment with your oncology team is a critical step in planning a successful path to recovery.