The Role of Radiation Therapy in Patients with Relapsed/Refractory Hodgkin Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Louis S. Constine, Joachim Yahalom, Andrea K. Ng, David C. Hodgson, Andrew Wirth, Sarah A. Milgrom, N. George Mikhaeel, Hans Theodor Eich, Tim Illidge, Umberto Ricardi, Karin Dieckmann, Craig H. Moskowitz, Ranjana Advani, Peter M. Mauch, Lena Specht, Richard T. Hoppe
Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early and advanced stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood in order to maximize our success in treating these patients. The complexity of treating relapsed/refractory HL derives from the spectrum of primary treatment approaches currently in use that creates heterogeneity in both treatment exposure and the potential toxicities of salvage therapy. Patients can have relapsed or refractory disease after limited or aggressive primary therapy (with or without radiation therapy), at early or delayed time points, with limited or extensive disease volumes, and with varying degrees of residual morbidity from primary therapy. Their response to salvage systemic therapy can be partial or complete, and the use of consolidative stem cell transplant is variably applied. New biologics and immunotherapeutic approaches have broadened but also complicated salvage treatment approaches. Through all of this, radiation therapy remains an integral component of treatment for many patients but it must be used effectively and judiciously. The purpose of this review is to describe the different treatment scenarios and provide guidance for radiation dose, volume, and timing in patients with relapsed or refractory HL.



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