When the anatomical distribution and clinical stage of Hodgkin's disease have been established, rational decisions concerning the treatment of choice can be made. The initial therapeutic decision is crucial since the first course of treatment undoubtedly has the greatest chance of success. Depending upon circumstances, the physician must select one of three therapeutic options: (1) treatment with curative intent; (2) treatment with palliative intent; and (3) continued observation with general supportive care, with specific therapy held in reserve. The clinical stage of the disease is undoubtedly the most important factor influencing the selection of treatment.
Only a decade ago, treatment with curative intent would have been deemed appropriate only for stage I disease, and for cases of localized, favorable stage II disease. Modern megavoltage apparatus has made possible the successful use of total lymphoid radiotherapy in cases of stage III and localized Rye stage IV10 (Ann Arbor stage II