title: Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG).
abstract: Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced volumes and doses is addressed, integrating modern imaging with 3-dimensional (3D) planning and advanced techniques of treatment delivery. The previously applied extended field (EF) and original involved field (IF) techniques, which treated larger volumes based on nodal stations, have now been replaced by the use of limited volumes, based solely on detectable nodal (and extranodal extension) involvement at presentation, using contrast-enhanced computed tomography, positron emission tomography/computed tomography, magnetic resonance imaging, or a combination of these techniques. The International Commission on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom optimal imaging is available, is explained. A new concept, involved site radiation therapy (ISRT), is introduced as the standard conformal therapy for the scenario, commonly encountered, wherein optimal imaging is not available. There is increasing evidence that RT doses used in the past are higher than necessary for disease control in this era of combined modality therapy. The use of INRT and of lower doses in early-stage HL is supported by available data. Although the use of ISRT has not yet been validated in a formal study, it is more conservative than INRT, accounting for suboptimal information and appropriately designed for safe local disease control. The goal of modern smaller field radiation therapy is to reduce both treatment volume and treatment dose while maintaining efficacy and minimizing acute and late sequelae. This review is a consensus of the International Lymphoma Radiation Oncology Group (ILROG) Steering Committee regarding the modern approach to RT in the treatment of HL, outlining a new concept of ISRT in which reduced treatment volumes are planned for the effective control of involved sites of HL. Nodal and extranodal non-Hodgkin lymphomas (NHL) are covered separately by ILROG guidelines.
authors.affiliation: Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: lena.specht@regionh.dk.
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Joachim
authors.initials: J
authors.lastname: Yahalom
authors.affiliation: Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Christie Hospital NHS Trust, Manchester, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Illidge
authors.affiliation: Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Anne Kiil
authors.initials: AK
authors.lastname: Berthelsen
authors.affiliation: Department of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
authors.affiliation: Department of Radiation Oncology, University of Münster, Germany.
authors.forename: Hans Theodor
authors.initials: HT
authors.lastname: Eich
authors.affiliation: Department of Radiation Oncology, Institut Gustave-Roussy, Villejuif, France.
authors.forename: Theodore
authors.initials: T
authors.lastname: Girinsky
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, California.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Hoppe
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts.
authors.forename: Peter
authors.initials: P
authors.lastname: Mauch
authors.affiliation: Department of Clinical Oncology and Radiotherapy, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: N George
authors.initials: NG
authors.lastname: Mikhaeel
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ng
mesh_terms: D006689:Hodgkin Disease / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D015182:Lymphatic Irradiation / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods; D058958:Organs at Risk / Q000528:radiation effects; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated; D047368:Tumor Burden