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Abstract
Currently, Hodgkin's lymphoma (HL) has an excellent clinical outcome, with overall survival of approximately 90% in early stages of the disease. Based on young age of the majority of patients at the time of diagnosis and their long survival time, increased attention has been focused on long-term toxicity of therapy. While novel, directly targeting antitumor agents, with an excellent safety profile, have been developed for HL treatment, the role of radiotherapy is still debated. Radiotherapy may induce cardiovascular disease and impairment of thyroid or pulmonary function and, most importantly, may lead to development of secondary cancers. As a consequence, the current radiation therapy planning paradigm is mainly focused on a reduction of field size. As it was investigated in clinical trials regional therapy is as effective as extended field radiotherapy, but less toxic. Although chemotherapy is the mainstay of HL treatment, consolidative involved field radiation therapy is still considered to be the standard of care in both early and advanced stages. Recently, further field reduction has been investigated to further decrease the late radiation-induced toxicity. In this paper we describe the role and safety profile of radiotherapy in the past and present and hope for the novel techniques in the future.
Highlights
Hodgkin’s lymphoma (HL) is a clonal malignancy of the lymphatic system that arises from B-cells of germinal and postgerminal centres
Based on differences in the histological picture and the neoplastic cell phenotype HL can be divided into two distinct subgroups: classical HL which is recognized in majority of patients (95%) and nodular lymphocyte-predominant HL (5%). cHL type can be further divided into four subtypes: lymphocyte-rich lymphocyte-predominant (LR-LP), nodular sclerosis (NS), mixed cellularity (MC), and lymphocytedepleted (LD) [3]
RT along with ABVD regimen is still standard of care in early stages of the disease, as well as in advanced stages, when there is a large residual mass observed after chemotherapy according to European Society for Medical Oncology (ESMO) guidelines [19]
Summary
Hodgkin’s lymphoma (HL) is a clonal malignancy of the lymphatic system that arises from B-cells of germinal and postgerminal centres. Before finding a reliable treatment, HL was a fatal disease with progressive presentation and poor clinical outcome. Nowadays, it can be successfully treated with chemo- and radiotherapy (RT) in great majority of patients, with long-term survival exceeding 80% [5]. BioMed Research International chemotherapy with consolidative autologous stem cell transplantation (autoSCT) is a standard of care. Prognosis for those groups is rather poor with possibility to achieve a complete remission (CR) in less than 50% with a median overall survival (OS) of approximately 2 years [7]. It was discovered that regional therapy is as effective as extended field RT (EF-RT), whereas less toxic
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