Complications of total nodal irradiation of Hodgkin's disease stages III and IV

One hundred twenty‐seven patients with Hodgkin's disease, Stages III‐IV, received total nodal irradiation. Of these, 101 patients were managed primarily by radiation therapy employing the split course sequential segmental radiation technique called the “3 & 2”. A dose of 3800–4000 rad is delivered in 2 phases in an overall period of 12 to 13 weeks (TDF 61–64; 1094–1148 rets). For various reasons, the remaining 26 patients received their mantle irradiation to full doses 3800–4000 rad in 4 weeks (TDF 63–66; 1112–1184 rets) without rest periods and a few were irradiated after failing chemotherapy. Of the 101 patients treated between 1969–1974 using the “3 & 2” technique, 2 developed pericarditis (2.0%), none manifested symptomatic pneumonitis (0%), and 3 hypothyroidism (3.0%). The low incidence of severe complications is primarily the result of the technique employed to give total nodal irradiation. The overall incidence of Herpes Zoster was 42% (53/127), and there was a slightly higher incidence when TNI was given following splenectomy.