Severalrs ago, the value of a combination of radiotherapy and chemotherapy in the treatment of Hodgkin's disease was suggested by several authors,47-49 but was debated by others.50 Both radiotherapy and chemotherapy have since made considerable progress; however, there are still advantages to combining the modalities.
Radiotherapy acts only on the neoplastic tissues that are located within the irradiated zones. For these tissues, the probability of recurrence decreases with the local radiation dose; but, it is never completely impossible. The dose is limited by the risk of local injury, especially in sensitive tissues such as the mediastinum or the spinal cord. The sequelae caused by the irradiation of the liver or of the lungs are so severe that their radical irradiation is practically impossible. Irradiation of the gonads in young patients carries genetic hazards that cannot be neglected.
Extensive chemotherapy has become more and more efficient during the last decade. Aplasia of hematopoietic tissue represents the major limitating factor; in many cases this prevents sterilization of all the