Hodgkin's disease is one of several malignant disorders of the lymphatic and other tissues that play a part in an individual's ability to fight infection. Young adults, aged 20 to 40, are most often affected by this relatively uncommon type of cancer.

The 6 MEV linear accelerator

The 6-MEV linear accelerator, which delivers super-voltage X-rays, is shown being positioned as for treatment of a patient. Supervoltage X-ray is highly effective in treating Hodgkin's disease in its early stages.

Supervoltage X-ray is the preferred treatment for the early stages of Hodgkin's disease, when it is usually confined to one or two regions of the body. Each lymph node region involved and the adjacent region is subjected to intensive X-ray therapy over a period of several weeks. Evidence has accumulated indicating that about 50 percent of patients treated by this method in an early stage of their disease survive more than 15 years, and may be considered as cured.

Recent information about the spread of the disease in the body indicates that the potential for cure may be substantially increased by early diagnosis. Hodgkin's disease appears to originate in a single site and then spread not randomly but to contiguous lymphatic tissues through lymphoid channels.

Chemotherapy has played a role in the management of advanced disease since 1946, when nitrogen mustard was found to be active in producing temporary regression of Hodgkin's disease. Since then, other drugs have proved useful against advanced Hodgkin's disease; these include thioTEPA, cyclophosphamide, vincristine, vinblastine, methyl hydrazine derivative (ibenzmethyzin), and streptonigrin. Massive doses of hormonal compounds such as prednisone also can cause some regression, but toxic effects may be severe.

In the past several years, studies of intensive combination chemotherapy have produced encouraging results against widespread Hodgkin's disease. One National Cancer Institute pilot study of 14 patients in all stages of the disease utilized a combination of drugs representing four different classes; the drugs were cyclophosphamide, vincristine, methotrexate, and prednisone. Radiotherapy followed chemotherapy as needed. The complete remission rate for the patients with generalized disease was 80 percent and for all patients, 86 percent. At the time of reporting, a few of the patients remained free of disease more than 30 months after treatment.

A later 4-drug study of 30 patients with advanced Hodgkin's disease utilized a regimen of six 28-day courses of nitrogen mustard, vincristine, methyl hydrazine derivative, and prednisone. Still in progress, the study has confirmed the results of the earlier combination chemotherapy clinical trial. Almost all of the patients achieved complete remission. As of March 1968, the mean duration of unmain-tained remissions among these patients was 18 months, and 18 patients were continuing in complete remission.

Intensive study of the therapy of Hodgkin's disease is continuing. Chemotherapy may make patients more susceptible to curative treatment with X-ray, and a combination of chemotherapy and radiotherapy may prove of greater benefit than either method of treatment alone.