In Reply.–I am sorry that Dr Kadin missed the major point of our article. Our purpose was not to delve into the semantics of modern radiation therapy. Instead, we emphasized that if extensive radiotherapy or chemotherapy are to be used in Hodgkin's disease regardless of the surgical findings, then the staging laparotomy is not needed.
The terms mantle, extended-field, and total nodal radiation are indeed confusing because they have never been precisely defined and accepted as such by all radiotherapists. We did not attempt to define these terms in our report. We stressed, and I would like to mention again, that treatments were highly individualized. The use of "extended radiation" in this study referred to mantle radiation with an extended field, or extended-field radiation, as defined by Dr Kadin. Stage IIA patients often received this extended-field radiation, but this was dependent on the degree of supradiaphragmatic involvement and histologic
O'HOLLERAN TP. Staging Laparotomy in Hodgkin's Disease. Arch Surg. 1981;116(3):367–368. doi:10.1001/archsurg.1981.01380150085025
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