In many centers, involved field radiation is administered to the mediastinum after completion of the chemotherapy. In other centers, patients undergo high-dose chemotherapy and autologous stem cell transplantation after completing combination chemotherapy. Management is guided by evaluation of the response on CT and gallium scan. There is no other role for surgery. The mainstay of therapy consists of combination chemotherapy.
Regimens are complex and doses vary depending on a patient's weight and body surface area.
They usually contain corticosteroids, an anthracycline, an alkylating agent, and a vinca alkaloid. Other agents such as methotrexate and bleomycin are sometimes used. Some of the patients are young women who may be pregnant at the time of diagnosis. The management of malignancy during pregnancy raises specific and complex issues. Concern over the patient's health needs to be balanced with the potential teratogenicity of the chemotherapy and the radiation administered for diagnostic exams or as part of treatment.