Lymphoma

While radiation therapy alone was historically used in the early management of both Hodgkin and non-Hodgkin lymphoma, the advent of effective systemic therapy shifted the treatment paradigm toward combined modality therapy. Despite substantial evidence establishing the importance of radiation therapy in local control for both Hodgkin and non-Hodgkin lymphoma, controversy surrounding its use in certain patient populations still exists, in large part, because of concerns of late toxicity resulting in morbidity and mortality in lymphoma survivors. In response, significant efforts have been made to refine the delivery of radiation therapy in the combined modality setting such that toxicity is minimized while still preserving disease control. Advances in imaging and treatment delivery, including use of 3D conformal therapy, intensity-modulated radiation therapy, and proton therapy, have allowed for more conformal radiotherapy delivered to smaller fields with lower doses. At the same time, efforts to identify which patients would benefit most from radiation therapy, using risk stratification and response-based assessment, are providing further guidance on the development of individually tailored treatment regimens that incorporate radiotherapy in the most beneficial manner. Continued investigation on radiation field size, dose, and advanced delivery techniques is needed to ensure clinical efficacy is not compromised with treatment de-intensification and increased conformality.