title: Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group.
abstract: Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.
authors.affiliation: Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom. Electronic address: Tim.Illidge@ics.manchester.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Illidge
authors.affiliation: Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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: Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Berthe
authors.initials: B
authors.lastname: Aleman
authors.affiliation: Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne Kiil
authors.initials: AK
authors.lastname: Berthelsen
authors.affiliation: Departments of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Constine
authors.affiliation: Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Bouthaina
authors.initials: B
authors.lastname: Dabaja
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Kavita
authors.initials: K
authors.lastname: Dharmarajan
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
authors.affiliation: Radiation Oncology Unit, Department of Oncology, University of Torino, Torino, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wirth
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods* / Q000592:standards; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D058958:Organs at Risk; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D047368:Tumor Burden