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Several prognostic and risk evaluation tools have been developed to stratify patients with early stages in different risk categories with the aim to adapt the intensity and duration both of chemotherapy and RT. Up to now, four large randomized studies have definitively demonstrated the superiority of the combination of chemotherapy and RT over RT alone both in favorable and unfavorable early stages. Moreover, after three to four cycles of chemotherapy, an IFRT at 20 Gy can replace the more-toxic EFRT. ABVD remains the standard treatment in these patients. Patients with unfavorable early-stage disease should receive chemotherapy with four to six courses of ABVD followed by IFRT (30 Gy, with additional 6 Gy to the http://www.selleck.cn/products/Staurosporine.html bulk) [52�C58]. In an attempt to reduce long-term toxicity of these patients, four studies have evaluated the role of chemotherapy alone [59�C62]. At present, data on the effectiveness of chemotherapy alone compared with combined modality treatment are not conclusive and do not allow to recommend this method outside of clinical trials. The first chemotherapeutic regimen widely used to treat advanced disease was MOPP, with half patients cured but with significant long-term toxicity [63, 64]. After the evaluation of efficacy data of ABVD, several randomized trials have demonstrated the superiority of the latter scheme compared with MOPP [65, 66]. Subsequently, several studies that have evaluated the http://www.selleckchem.com/products/ly2109761.html effectiveness of combined strategies MOPP/ABVD or alternating hybrids showed that ABVD is superior to MOPP and comparable to the hybrid or alternating patterns but with less toxicity [67�C72]. Two randomized trials have demonstrated that the systematic use of IFRT after six to eight http://www.selleckchem.com/products/epz-5676.html cycles of chemotherapy does not improve results and is, therefore, to be avoided in patients in CR at the end of chemotherapy [73, 74]. More controversial is the need to irradiate or not bulky areas (>10 cm) at presentation, although the preliminary results of a recent German trial suggest the possibility of avoiding this type of radiation [75]. The ABVD six to eight cycles followed by IFRT only on bulky masses must, therefore, be considered, in our opinion, the gold standard for advanced Stages IIB�CIV. However, with regard to the role of radiation in advanced disease as well as in early-stage disease, there is not a broad consensus, at least in North America. It remains to define the role of BEACOPP that has not yet demonstrated a clear superiority over ABVD, although some randomized studies seem to show an advantage for this scheme in comparison with classical ABVD or hybrid regimens, though with a significantly higher toxicity [76�C80].