To the Editor: A simpler alternative to the staging procedures for Hodgkin's disease recently discussed in the Journal1,2 is to first use laparotomy in certain asymptomatic adults. We derived this approach from a computer-based decision-analysis program that devises staging and treatment plans, according to predictions of the likely pathological stage.3 Our experience with more than 900 pathologically staged patients with Hodgkin's disease shows that there is no presenting pattern of involved nodes for which one can know with certainty that there is no infradiaphragmatic involvement. There are, however, some situations in which infradiaphragmatic disease is unlikely. Even for persons least. No extract is available for articles shorter than 400 words.
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