American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of therapy is indicated for patients with Hodgkin lymphoma and extracellular extension lymph nodes?

1. Chemotherapy alone

2. Adjuvant radiotherapy only

3. Combination therapy of chemotherapy and radiotherapy

4. Supportive care only

The correct answer is: Combination therapy of chemotherapy and radiotherapy

In the treatment of Hodgkin lymphoma, particularly when there is evidence of extranodal extension or involvement of lymph nodes in regions beyond the primary site, the most effective approach is typically combination therapy that includes both chemotherapy and radiotherapy. Combining these treatments maximizes the efficacy of the therapeutic regimen, targeting the lymphoma cells with chemotherapy while also addressing any residual disease or localized areas of concern with radiation. Chemotherapy helps to reduce tumor burden systemically, while radiotherapy is particularly effective at addressing localized disease and residual masses. The rationale behind this combination approach is supported by clinical evidence showing that patients with more extensive disease or those with extranodal involvement tend to have improved outcomes when both modalities are utilized compared to either treatment alone. This comprehensive strategy assists in achieving higher rates of remission and lower chances of relapse. In contrast, solely administering chemotherapy may not adequately address localized disease, and adjuvant radiotherapy alone does not provide the systemic treatment necessary for lymphoma. Supportive care only would not address the underlying malignancy and would leave the disease untreated, which is not appropriate for patients with Hodgkin lymphoma exhibiting extension into extralymphatic sites. Thus, the combination of chemotherapy and radiotherapy stands out as the most effective and indicated treatment option in this scenario.