The re-appearance of nodal disease following radical irradiation with extended field technique (mantle or inverted Y) can rarely be controlled by further aggressive irradiation. The majority of nodal recurrences, regardless of how localized they are, eventually progress to extranodal sites. Managing nodal recurrences with irradiation often presents special problems due to overlap of fields and to risk of re-irradiation of vital normal structures, especially the spinal cord. This report is a retrospective review of 123 patients with clinical Stages I and II Hodgkin’s disease who have been treated with either extended field irradiation (mantle technique) or total nodal irradiation. The 5 year survival rates after the first relapse are: 50 per cent for patients with local nodal recurrence; 27 per cent for patients with transdiaphragmatic nodal extension; and 0 per cent for those with disseminated disease. The transdiaphragmatic extension, which is the most common recurrence pattern after treatment with mantle irradiation, has been eliminated by elective irradiation of paraaortic nodes utilizing the total nodal irradiation technique.