Results of radiation therapy and implications for the clinical staging of Hodgkin's disease.

disease, thereby minimizing normal tissue reactions and complications without concurrent loss of therapeutic effectiveness. Insistence upon well-tolerated radiation dose schedules is particularly important in light of both the excellent prognosis for many patients and the need for extensive prophylactic irradiation if optimal results are to be achieved. Establishment of the requirement for prophylactic irradiation in a prospective, randomly controlled clinical trial now focuses attention on the subject of defining with maximal precision the extent to which apparently uninvolved areas must be empirically treated. The major handicap in pretreatment diagnostic evaluation at present is the inability to detect minute foci of extranodal dissemination, which bars successful control of disease with irradiation alone. Some possibility of identifying these patients prospectively is provided by either clinicohistological correlations as discussed or by the observation of vascular invasion on the original lymph node biopsy; whereas routine exploratory laparotomy rarely contributes to therapeutic management for clinical presentations above the diaphragm and does not appear warranted in such cases, those selected patients with clinical disease below the diaphragm may often have treatment decisions modified by surgical findings on abdominal exploration.