Radiation therapy in Hodgkin's disease - decades of steady progress

The treatment of lymphoproliferative diseases has changed dramatically during the last decades. The improved therapeutic results for this disease group are included among the most important achievements of modern oncohaematology. They are due to better disease staging, use of new markers for risk assessment, patient stratification in separate risk groups, implementation of highly effective chemotherapy (CHT), progress of targeted therapies using monoclonal antibodies, proteasome inhibitors, modern radiation therapy (RT) and supportive care. The achieved progress, especially in the treatment of Hodgkin's disease (HD), is an example of the fundamental dependence of clinical practice on the scientific achievements, mainly in the field of diagnostics and in the two pure anticancer therapeutic modalities: chemo- and radiotherapy. The aim of this article was to discuss the basic variants of RT in the multimodal treatment of HD and the clinical experience accumulated during the last decades. The experience gained in the area of involved field RT (IFRT) and extended field RT (EFRT), both alone or as a part of the combined-therapy protocols, is considered in detail. The role of RT is also discussed as a part of the dose-escalated CHT combined programmes for patients recurring, progressing or partially responding to treatment, carried out mainly as IFRT, total lymphoid irradiation (TLI) or total body irradiation (TBI). Regardless of the already attained achievements of the combined treatment at the present stage of development of oncological knowledge, there is still no consensus with respect to the optimal therapy of HD in children and in adult patients. New trials addressing issues of the best modality, best RT technique, optimal dose of RT, optimal number of cycles and timing of CHT are still needed. The contemporary challenge is to optimize treatment so that it can be accomplished with the least toxicity, lowest cost, and greatest efficiency possible.