Patterns of Spread

David W. Smithers, MD, FRCP, FFR
JAMA. 1972;222(10):1298-1299. doi:10.1001/jama.1972.03210100046015.
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Success in the treatment of Hodgkin's disease during the last few years has followed improved methods to detect the extent of the disease, better estimation of the likely rate of advance, and more efficient application of radiation therapy and chemotherapy. All three (detection of involvement, forecast of further dissemination, and extent and method of treatment) have contributed to or depended on a better understanding of the modes and directions of spread of the disease.

Misunderstandings and inaccuracies in the estimate of degree of spread may be overcome to some extent by making splenectomy and total nodal irradiation routine procedures. While this is likely to improve overall survival figures, some patients will receive more extensive treatments than they need, which may be dangerous. The chance of success with chemotherapy may be seriously prejudiced in those patients who still develop spread to nonlymphoid organs. Thus, a better understanding of the mode and


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