Role of radiation therapy in Hodgkin's lymphoma

Radiation therapy was the first modality that solely cured patients with Hodgkin's lymphoma (HL) as early as the 1940s. In the absence of other curative options, the radiation field in full dose was extended to encompass both involved and uninvolved sites including many normal organs. Decades later, it was evident that some of the HL survivors succumbed to radiation-related effects, mostly second solid tumors. The more recent reliance on modern chemotherapy in combination with radiation yielded further improvement in disease control and allowed a marked reduction in radiation exposure. Some oncologists even suggested that chemotherapy alone might retain the excellent results obtained with combined modality and campaigned for the exclusion of radiotherapy from the treatment program. However, analysis of randomized studies (as discussed later) supports the inclusion of reduced-field and dose radiotherapy in treatment programs for HL. Furthermore, new concerns regarding the short- and long-term safety of enhancing chemotherapy to compensate for the omission of radiotherapy favor shorter courses of chemotherapy. Short chemotherapy supplemented with mini-radiotherapy constitutes a highly effective and safe treatment of HL, particularly in early stages.