Perspective on staging approaches in the malignant lymphomas

The value of staging in malignant lymphomas is underscored by the advances made in therapeutic options. Through the years, it has become clear that combined modality therapy should be avoided if possible because of the increased risk of second malignant diseases. Thus, it is crudial to define those patients who are potentially cured by limited therapy, such as radiotherapy alone, or combination chemotherapy. This means that careful clinical staging with the best roentgenographic techniques currently available is necessary. At institutions, such as the University of Chicago and Stanford Univeristy, it is important to determine nodal disease that is potentially cured with radiotherapy (I through III, III₁, at the University of Chicago). In non-Hodgkin's lymphoma, such as poorly differentiated lymphoma and diffuse histiocytic lymphoma, only a small percentage of patients in certain centers who have truly localized Stage I disease may benefit from radiotherapy alone. It is these groups of patients who may need surgical staging. Thus, in 1986, only a small percentage of patients with non-Hodgkin's lymphoma will actually benefit in terms of therapeutic options from the staging laparotomy. Perhaps as newer imaging techniques, such as magnetic resonance imaging, become available, the staging laparotomy may become obsolete.