Role of radiotherapy in Hodgkin lymphoma

Background The role of radiotherapy (RT) in the treatment of Hodgkin lymphoma (HL) has changed considerably over time. Nevertheless, it remains an integral part of combined-modality therapy; however, the increasing use of immunotherapeutics means that the role of RT will be re-evaluated. This article provides an up-to-date review of RT in HL covering indications, target volume concepts, side effects, and a look to the future. Materials and methods A review of RT in HL was performed using a literature search and current guidelines. Results According to current studies, modern RT in HL continues to be the standard of care in the early stages with 20 Gy involved site RT (IS-RT). In the intermediate stages, based on the HD17 study, positron emission tomography (PET)-guided 30 Gy IS-RT has become the standard of care, so that all PET-negative patients are no longer irradiated after chemotherapy. In advanced stages, local RT continues to be given in patients with positive PET after chemotherapy with 30 Gy. In addition, new target volume concepts, such as IS-RT, have led to a further reduction in RT fields, aiming for a reduction in late side effects and secondary malignancies. Looking ahead, the emergence of checkpoint immunotherapy has significantly changed the treatment of HL. The role and benefits of RT must now be explored in this environment as well, and initial results appear promising. Conclusion Although the role of RT in the treatment of HL has changed significantly over the decades, it appears that it will also remain an important part of combined-modality therapy for HL in the future