Vragen rond aanvullende radiotherapie bij patiënten met de ziekte van Hodgkin stadium III of IV, in remissie na chemotherapie

– The role of additional radiotherapy in the treatment of patients with advanced stages of Hodgkin's disease is still controversial.

– Additional radiotherapy is intended to eradicate any persistent disease to reduce recurrence rates and improve survival.

– The radiotherapy is applied to the lymph node stations or the organs affected at first presentation as most relapses after a chemotherapy-induced remission occur in previously involved sites of disease.

– Residual abnormalities on radiologic analysis after chemotherapy are present in the vast majority of the patients and a reliable method of separating active disease from fibrotic remnants is still lacking.

– Long-term toxicity data of combined chemotherapy and radiotherapy show an increased incidence of secondary malignancies and cardiac and pulmonary disease.

– Randomised studies are not conclusive as yet. Although, at least in subgroups of patients, the recurrence rates appear to decrease after additional low-dose involved-field radiotherapy, improvement of overall survival has not been demonstrated.