The chemotherapeutic implications of staging are the following. (a) As both radiotherapeutic and chemotherapeutic treatment programs become more aggressive, the decision as to what stage a patient resides in becomes more important since both programs may be mutually exclusive. (b) More complete approaches to staging are yielding previously unappreciated areas of disease involvement. More and more patients are exhibiting less and less localized disease. The implication may be that Hodgkin's disease, particularly in reference to splenic involvement and vascular invasion, may metastasize more often than previously appreciated. (c) Development and application of chemotherapy for Hodgkin's disease has now reached the point where it provides the therapy of choice for patients with Stage IIIB and IV disease and may be even more useful in patients with minimal amounts of widespread disease of the type uncovered by current staging techniques. (d) With our better understanding of the natural history of Hodgkin's disease and the availability of two alternative therapeutic approaches, we should now be able to approach itelligently the design and execution of clinical trials within given stages of disease, (e) The question as to whether removal of the spleen is useful in allowing delivery of more chemotherapeutic agents with less toxicity in the newly staged patient is unsettled and will require such a controlled clinicalt rial for the answer.

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