Chemotherapy only in early-stage Hodgkin lymphoma: More relapses but “same” (or possibly worse) survival – Reconsidering the misguided trend to omit radiotherapy

The standard treatment of early-stage Hodgkin lymphoma (ESHL) as recommended by most national guidelines is combined modality treatment (CMT) that includes a short course ABVD followed by a small field of low dose radiotherapy (RT). Recently a trend to treat patients with more chemotherapy alone has been promoted by some claiming that chemotherapy alone is good enough, and the overall survival is similar. These arguments need to be carefully examined, and the risk of more chemotherapy upfront and salvage considered. The suggestion that interim PET will identify patients that can have similar results with chemotherapy alone has recently been questioned by the results of both European and UK studies. It is the subject of this critical review.