American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an effective treatment for stage I and II Hodgkin lymphoma without B symptoms?

1. Observation alone

2. Chemotherapy only

3. Surgery alone

4. Radiation alone or combined with short-course chemotherapy

The correct answer is: Radiation alone or combined with short-course chemotherapy

For stage I and II Hodgkin lymphoma without B symptoms, the recommended treatment often includes radiation therapy, which can be used alone or in combination with short-course chemotherapy. This approach is effective because localized Hodgkin lymphoma can be managed through targeted radiation, especially when there is no evidence of extensive disease or systemic symptoms like fever or weight loss. The rationale behind using radiation alone or with chemotherapy for early-stage Hodgkin lymphoma stems from the fact that these stages typically have a higher cure rate with this combination. Radiation therapy effectively targets the specific areas where the disease is present, reducing the risk of recurrence. Adding short-course chemotherapy may help to further reduce tumor burden and enhance outcomes, minimizing the chances of the disease spreading. In contrast, observation alone does not actively treat the disease and could lead to disease progression. Chemotherapy alone might be a treatment option but is not typically the first line for early-stage disease, as localized treatments are more effective. Surgery alone is not appropriate in this context, as Hodgkin lymphoma is primarily a lymphatic disease that requires systemic management rather than just surgical intervention. Thus, using radiation, especially in the absence of systemic symptoms, is the most effective approach.