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Outcomes of Hodgkin's disease.

C.T. scans of a Hodgkin's Disease patient with much enlarged lymph nodes lying beside the trachea (red arrowed in left figure) and after curative chemotherapy and radiotherapy.
C.T. scans of a Hodgkin's Disease patient with much enlarged lymph nodes lying beside the trachea (red arrowed in left figure) and after curative chemotherapy and radiotherapy.

By the above means, most patients with Hodgkin’s disease will go into first time remission and hopefully never relapse i.e. are cured.

 

The cure rates for early Hodgkin's disease are in the region of 87-95%. The photo (left panel) shows a CT scan of the chest (in cross-section) with a lump of Hodgkin's disease arrowed in red. In the right panel it can be clearly seen that the lump has disappeared after a course of curative therapy- the structures that are left are the normal ones.

 

What happens if the treatment is not successful? If a patient relapses after a radiotherapy-only programme, given for stage 1 disease, then there is no compromise to the good expectations of cure from chemotherapy and, if the patient has been followed up assiduously, then the relapse will have been picked up early and the chance of cure from such chemotherapy will be good.

 

Where the patient has presented with more advanced Hodgkin’s disease and has relapsed after a full chemotherapy programme, then the situation is more complex. The chance of second time cure with alternative orthodox dosage chemotherapy is nothing like as high as first time around, perhaps only 25%-50% (depending on the intensity and durability of the firs time response).

 

In this group of patients, the practice of delivering the alternative orthodox dosage chemotherapy and then (having achieved a response) delivering high dose chemotherapy (so high as to take the patient beyond bone marrow death) and then performing bone marrow rescue with peripheral stem cells (harvested from the blood of the patient as a contingency plan when he was in remission) is the most promising plan of management.

 

Booster radiotherapy to sites of bulky relapse may be also employed. By such means, cure may often be achievable. 

 

Some patients develop drug and radiation resistant disease and then their management is, as for any other cancer that has progressed beyond hope of cure, palliative; with therapy directed towards symptoms of the moment and not at any bigger objective.


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