A patient with Hodgkin's lymphoma presents with isolated cervical lymphadenopathy. Biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:
|A||Chemotherapy with Radiotherapy|
|D||No treatment needed|
Chemotherapy with Radiotherapy
The cell histology in Hodgkin's lymphoma is not as important as it is in non-Hodgkin's lymphoma: the treatment and prognosis in classic Hodgkin's lymphoma usually depends on the stage of disease rather than the histotype.
Stage I is involvement of a single lymph node region (I) (mostly the cervical region) or single extralymphatic site (Ie); Stage II is involvement of two or more lymph node regions on the same side of the diaphragm (II) or of one lymph node region and a contiguous extralymphatic site (IIe); Stage III is involvement of lymph node regions on both sides of the diaphragm, which may include the spleen (IIIs) and/or limited contiguous extralymphatic organ or site (IIIe, IIIes); Stage IV is disseminated involvement of one or more extralymphatic organs. (The absence of systemic symptoms is signified by adding 'A' to the stage; the presence of systemic symptoms is signified by adding 'B' to the stage)
1. Patients with clinical stages I or II with bulky disease, with or without unfavorable factors (ie, elevated ESR, >3 sites of involvement, B symptoms, extranodal disease), are classified as having early-stage disease with unfavorable factors. Chemotherapy plus involved-field XRT(radiation therapy) is indicated for these patients. In general, these patients would be treated with 2 cycles of ABVD.
2. In patients with advanced Hodgkin lymphoma, involved-field XRT can be used for sites of persistent disease following chemotherapy.