Radiotherapy for Hodgkin Lymphoma: Reducing Toxicity While Maintaining Efficacy

Radiation therapy (RT) for Hodgkin lymphoma has changed dramatically over the past couple of decades, from the very large extended-field RT with prophylactic treatment of all the major lymph node regions to the very limited involved-site RT with treatment only of the initially macroscopically involved lymphoma volume in the combined modality setting. Technological developments in imaging, treatment planning, and treatment machines have enabled very significant reductions in radiation doses to normal organs without jeopardizing the coverage of the lymphoma. Hence, the risks of long-term adverse effects have become much smaller than those in the past. Radiation therapy for Hodgkin lymphoma is now a highly individualized treatment, tailored to each patient. The risks of this limited RT should be weighed against the risks of long-term toxicity of possible additional systemic treatment up-front and at relapse in order to select the optimal treatment combination for each individual patient.