Involvement of LN regions on both sides of the diaphragm or a single extralymphatic organ, spleen or both. In addition, patients are designated as stage A if they lack constitutional symptoms, and as stage B if they are present. All patients with both localized and disseminated disease should be treated with curative intent. IA and IIA are treated with involved field irradiation. Treatment of stages IIB and IIIA is controversial.
Most centers recommend combined modality therapy.
IIIB and IV are treated with aggressive combination chemotherapy. Patients with stages IIIB or IV have 5 year survival rates of 50 to 60 percent. Patients with all favorable prognostic features have a disease-free survival rate of more than 70 percent at 4 years.