Advertisement

Principles of Radiation Therapy for Hodgkin Lymphoma

  • Joachim YahalomEmail author
  • Richard T. Hoppe
Chapter
Part of the Hematologic Malignancies book series (HEMATOLOGIC)

Abstract

Radiation therapy (RT) is a major component of the current successful treatment of Hodgkin lymphoma (HL). For decades, radiation was used alone to cure the majority of patients with HL; RT is still the most effective single agent in the oncologic armamentarium for this disease, and RT alone remains the treatment of choice for patients with early-stage lymphocyte predominance HL (LPHL) and for selected patients with classical HL who have contraindications to chemotherapy. Currently, most patients with HL are treated with combined-modality programs in which RT is given as consolidation after chemotherapy. As the role of RT has transformed over the years from a single modality into a component of combined-modality therapy, the classic principles of RT fields, dose, and technique have fundamentally changed.

Keywords

Planning Target Volume Hodgkin Lymphoma National Comprehensive Cancer Network Clinical Target Volume Gross Tumor Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

3DCRT

Three-dimensional conformal radiotherapy

ABVD

Adriamycin (doxorubicin) bleomycin, vinblastine, and dacarbazine

AP-PA

Opposed anterior and posterior fields

ASCT

Autologous stem cell transplantation

BEACOPP

Bleomycin etoposide, doxorubicin, cyclophosphamide, procarbazine, prednisone

CR

Complete response

CT

Computed tomography

CTV

Clinical treated

EBVP

Epirubicin, bleomycin, vinblastine, and dacarbazine

EFS

Event-free survival

EORTC

European Organisation for Research and Treatment of Cancer

FFTF

Freedom from treatment failure

GELA

Groupe d’Études des Lymphomes Adultes

GHSG

German Hodgkin Study Group

HL

Hodgkin lymphoma

IFRT

Involved-field radiation therapy

IMRT

Intensity-modulated radiation therapy

INRT

Involved-node radiation therapy

ISRT

Involved-site radiation therapy

LPHL

Lymphocyte-predominant HL

MOP-BAP

Mechlorethamine, Oncovin [vincristine], prednisone, bleomycin, Adriamycin (doxorubicin), and procarbazine

MOPP

Mustargen, Oncovin, procarbazine, prednisone

MSKCC

Memorial Sloan Kettering Cancer Center

NCCN

National Comprehensive Cancer Network

OS

Overall survival

PET

Positron emission tomography

PTV

Planned treatment volume

RT

Radiation therapy

STLI

Subtotal lymphoid irradiation

TLI

Total lymphoid irradiation

TSH

Thyroid-stimulating hormone

References

  1. 1.
    Hoppe RT, Advani R, Ai WZ et al (2012) Hodgkin Lymphoma, version 2.2012 featured updates to the NCCN guidelines. J Natl Compr Canc Netw 10:589–597PubMedGoogle Scholar
  2. 2.
    Yahalom J (2009) Role of radiation therapy in Hodgkin’s lymphoma. Cancer J 15:155–160PubMedCrossRefGoogle Scholar
  3. 3.
    Pusey W (1902) Cases of sarcoma and of Hodgkin’s disease treated by exposures to x-rays: a preliminary report. JAMA 38:166–169CrossRefGoogle Scholar
  4. 4.
    Senn N (1903) Therapeutical value of roentgen ray in treatment of pseudoleukemia. N Y Med J 77:665–668Google Scholar
  5. 5.
    Gilbert R (1925) La roentgentherapie de la granulomatose maligne. J Radiol Electrol 9:509–514Google Scholar
  6. 6.
    Peters M (1950) A study in survivals in Hodgkin’s disease treated radiologically. Am J Roentgenol 63:299–311Google Scholar
  7. 7.
    Kaplan H (1962) The radical radiotherapy of Hodgkin’s disease. Radiology 78:553–561PubMedCrossRefGoogle Scholar
  8. 8.
    Specht L et al (2014) Modern radiation therapy for Hodgkin lymphoma: Field and dose guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys 89(4):854–862. doi:  10.1016/j.ijrobp.2013.05.005. Epub 2013 Jun 18
  9. 9.
    Girinsky T, van der Maazen R et al (2006) Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol 79:270–277PubMedCrossRefGoogle Scholar
  10. 10.
    National Comprehensive Cancer Network Guidelines Version 2 (2014) Hodgkin lymphoma. http://www.nccn.org/
  11. 11.
    Nogova L, Reineke T, Eich HT et al (2005) Extended field radiotherapy, combined modality treatment or involved field radiotherapy for patients with stage IA lymphocyte-predominant Hodgkin’s lymphoma: a retrospective analysis from the German Hodgkin Study Group (GHSG). Ann Oncol 16(10):1683–1687PubMedCrossRefGoogle Scholar
  12. 12.
    Wirth A, Yuen K et al (2005) Long-term outcome after radiotherapy alone for lymphocyte-predominant Hodgkin lymphoma: a retrospective multicenter study of the Australasian Radiation Oncology Lymphoma Group. Cancer 104:1221–1229PubMedCrossRefGoogle Scholar
  13. 13.
    Chen RC, Chin MS et al (2010) Early-stage, lymphocyte-predominant Hodgkin’s lymphoma: patient outcomes from a large, single-institution series with long follow-up. J Clin Oncol 28:136–141PubMedCrossRefGoogle Scholar
  14. 14.
    Schlembach PJ, Wilder RB et al (2002) Radiotherapy alone for lymphocyte-predominant Hodgkin’s disease. Cancer J 8:377–383PubMedCrossRefGoogle Scholar
  15. 15.
    Engert A, Plutschow A, Eich HT et al (2010) Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med 363(7):640–652PubMedCrossRefGoogle Scholar
  16. 16.
    Eich HT, Diehl V, Gorgen H et al (2010) Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin’s lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol 28(27):4199–4206PubMedCrossRefGoogle Scholar
  17. 17.
    Radford J, Barrington S, Counsell N et al (2012) Involved field radiotherapy versus no further treatment in patients with clinical stages IA and IIA Hodgkin lymphoma and a ‘negative’ PET scan after 3 cycles ABVD. Results of the UK NCRI RAPID Trial [abstract]. Blood (ASH Ann Meet Abstr) 120(21):|547Google Scholar
  18. 18.
    Raemaekers JM, André MP, Federico M et al (2014) Omitting radiotherapy in early positron emission tomography-negative stage I/II Hodgkin lymphoma is associated with an increased risk of early relapse: Clinical results of the preplanned interim analysis of the randomized EORTC/LYSA/FIL H10 trial. J Clin Oncol 32(12):1188–1194. doi:  10.1200/JCO.2013.51.9298. Epub 2014 March 17
  19. 19.
    Evens AM, Kostakoglu L, (2014) The role of FDG-PET in defining prognosis of Hodgkin lymphoma for early-stage disease. Blood 124(23):3356–3364Google Scholar
  20. 20.
    Herbst C, Rehan FA et al (2009) Combined modality treatment improves tumor control and overall survival in patients with early stage Hodgkin lymphoma: a systematic review. Haematologica 95:494PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Loeffler M, Diehl V et al (1997) Dose-response relationship of complementary radiotherapy following four cycles of combination chemotherapy in intermediate-stage Hodgkin’s disease. J Clin Oncol 15:2275–2287PubMedGoogle Scholar
  22. 22.
    Aleman BM, Raemaekers JM et al (2003) Involved-field radiotherapy for advanced Hodgkin’s lymphoma. N Engl J Med 348:2396–2406PubMedCrossRefGoogle Scholar
  23. 23.
    Duggan DB, Petroni GR et al (2003) Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an intergroup trial. J Clin Oncol 21:607–614PubMedCrossRefGoogle Scholar
  24. 24.
    Laskar S, Gupta T et al (2004) Consolidation radiation after complete remission in Hodgkin’s disease following six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy: is there a need? J Clin Oncol 22:62–68PubMedCrossRefGoogle Scholar
  25. 25.
    Johnson PWM, Sydes MR, Hancock BW et al (2010) Consolidation radiotherapy in patients with advanced Hodgkin’s lymphoma: survival data from the UKLG LY09 randomized controlled trial. J Clin Oncol 28:3352–3359PubMedCrossRefGoogle Scholar
  26. 26.
    Engert A, Haverkamp H, Kobe C et al (2012) Reduced-intensity chemotherapy and PET-guided radiotherapy in patients with advanced stage Hodgkin’s lymphoma (HD15 trial): a randomised, open-label, phase 3 non-inferiority trial. Lancet 379(9828):1791–1799PubMedCrossRefGoogle Scholar
  27. 27.
    Gordon LI, Hong F, Fisher RI et al (2013) Randomized phase III trial of ABVD versus Stanford V with or without radiation therapy in locally extensive and advanced-stage Hodgkin lymphoma: an intergroup study coordinated by the Eastern Cooperative Oncology Group (E2496). J Clin Oncol 31:684–691PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Horning SJ, Hoppe RT et al (2002) Stanford V and radiotherapy for locally extensive and advanced Hodgkin’s disease: mature results of a prospective clinical trial. J Clin Oncol 20:630–637PubMedCrossRefGoogle Scholar
  29. 29.
    Chisesi T, Federico M et al (2002) ABVD versus stanford V versus MEC in unfavourable Hodgkin’s 9 lymphoma: results of a randomised trial. Ann Oncol 13(Suppl 1):102–106PubMedCrossRefGoogle Scholar
  30. 30.
    Poen JC, Hoppe RT et al (1996) High-dose therapy and autologous bone marrow transplantation for relapsed/refractory Hodgkin’s disease: the impact of involved field radiotherapy on patterns of failure and survival [see comments]. Int J Radiat Oncol Biol Phys 36:3–12PubMedCrossRefGoogle Scholar
  31. 31.
    Yahalom J, Gulati SC et al (1993) Accelerated hyperfractionated total-lymphoid irradiation, high-dose chemotherapy, and autologous bone marrow transplantation for refractory and relapsing patients with Hodgkin’s disease. J Clin Oncol 11:1062–1070PubMedGoogle Scholar
  32. 32.
    Moskowitz CH, Nimer SD et al (2001) A 2-step comprehensive high-dose chemoradiotherapy second-line program for relapsed and refractory Hodgkin’s disease: analysis by intent to treat and development of a prognostic model. Blood 97:617–623CrossRefGoogle Scholar
  33. 33.
    Moskowitz CH, Kewalramani T et al (2004) Effectiveness of high dose chemoradiotherapy and autologous stem cell transplantation for patients with biopsy-proven primary refractory Hodgkin’s disease. Br J Haematol 124:645–652PubMedCrossRefGoogle Scholar
  34. 34.
    Goodman KA, Riedel E et al (2008) Long-term effects of high dose chemotherapy and radiation for relapsed and refractory Hodgkin’s lymphoma. J Clin Oncol 26:5240–5247PubMedCrossRefGoogle Scholar
  35. 35.
    Yahalom J, Mauch P (2002) The involved field is back: issues in delineating the radiation field in Hodgkin’s disease. Ann Oncol 13(Suppl 1):79–83PubMedCrossRefGoogle Scholar
  36. 36.
    Kaplan HS, Rosenberg SA (1966) The treatment of Hodgkin’s disease. Med Clin North Am 50:1591–1610PubMedGoogle Scholar
  37. 37.
    ICRU. International Commission on Radiation Units and Measurements (1999) Prescribing, recording, and reporting photon therapy. (Supplement to ICRU report 50). ICRU report 62Google Scholar
  38. 38.
    Girinsky T, Specht L, Ghalibafian M, Edeline V, Bonniaud G, van der Maazen R, Aleman B, Paumier A, Meijnders P, Lievens Y, Noordijk E, Poortmans P (2008) The conundrum of Hodgkin lymphoma nodes: to be or not to be included in the involved node radiation fields. The EORTC-GELA lymphoma group guidelines. Radiother Oncol 88:202–210PubMedCrossRefGoogle Scholar
  39. 39.
    Hutchings M, Loft A, Hansen M, Pedersen LM, Berthelsen AK, Keiding S, D’Amore F, Boesen AM, Roemer L, Specht L (2006) Positron emission tomography with or without computed tomography in the primary staging of Hodgkin’s lymphoma. Haematologica 91:482–489PubMedGoogle Scholar
  40. 40.
    Maraldo MV, Aznar MC, Vogelius IR, Petersen PM, Specht L (2013) Involved node radiotherapy: an effective alternative in early stage Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 85:1057–1065PubMedCrossRefGoogle Scholar
  41. 41.
    Paumier A, Ghalibafian M, Beaudre A, Ferreira I, Pichenot C, Messai T, Lessard NA, Lefkopoulos D, Girinsky T (2011) Involved-node radiotherapy and modern radiation treatment techniques in patients with Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 80:199–205PubMedCrossRefGoogle Scholar
  42. 42.
    Duhmke E, Franklin J et al (2001) Low-dose radiation is sufficient for the noninvolved extended-field treatment in favorable early-stage Hodgkin’s disease: long-term results of a randomized trial of radiotherapy alone. J Clin Oncol 19:2905–2914PubMedGoogle Scholar
  43. 43.
    Duhmke E, Diehl V et al (1996) Randomized trial with early-stage Hodgkin’s disease testing 30 Gy vs. 40 Gy extended field radiotherapy alone. Int J Radiat Oncol Biol Phys 36:305–310PubMedCrossRefGoogle Scholar
  44. 44.
    Prosnitz LR (1976) Radiation doses following intensive chemotherapy in the treatment of Hodgkin’s disease. Int J Radiat Oncol Biol Phys 1:803–804PubMedCrossRefGoogle Scholar
  45. 45.
    Donaldson SS, Link MP (1987) Combined modality treatment with low-dose radiation and MOPP chemotherapy for children with Hodgkin’s disease. J Clin Oncol 5:742–749PubMedGoogle Scholar
  46. 46.
    Ferme C, Eghbali H et al (2007) Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 357:1916–1927PubMedCrossRefGoogle Scholar
  47. 47.
    Hodgson DC, Koh ES et al (2007) Individualized estimates of second cancer risks after contemporary radiation therapy for Hodgkin lymphoma. Cancer 110:2576–2586PubMedCrossRefGoogle Scholar
  48. 48.
    Kuttesch JF Jr, Wexler LH et al (1996) Second malignancies after Ewing’s sarcoma: radiation dose-dependency of secondary sarcomas. J Clin Oncol 14:2818–2825PubMedGoogle Scholar
  49. 49.
    Travis LB, Gospodarowicz M et al (2002) Lung cancer following chemotherapy and radiotherapy for Hodgkin’s disease. J Natl Cancer Inst 94:182–192PubMedCrossRefGoogle Scholar
  50. 50.
    Travis LB, Hill D et al (2003) Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin’s disease. JAMA 290:465–475PubMedCrossRefGoogle Scholar
  51. 51.
    van Leeuwen FE, Klokman WJ et al (2002) Effects of radiation dose, chemotherapy, and ovarian hormones on breast cancer risk following Hodgkin’s disease. In: Eighth international conference on malignant lymphoma, LuganoGoogle Scholar
  52. 52.
    Koontz B, Kirkpatrick J et al (2006) Combined modality therapy versus radiotherapy alone for treatment of early stage Hodgkin disease: cure versus complications. J Clin Oncol 24:605–611PubMedCrossRefGoogle Scholar
  53. 53.
    Salloum E, Doria R et al (1996) Second solid tumors in patients with Hodgkin’s disease cured after radiation or chemotherapy plus adjuvant low-dose radiation. J Clin Oncol 14:2435–2443PubMedGoogle Scholar
  54. 54.
    Arakelyan N, Jais J-P, Delwall V et al (2010) Reduced versus full doses of irradiation after 3 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine in early stage Hodgkin lymphomas. Cancer 116:4054–4062PubMedCrossRefGoogle Scholar
  55. 55.
    Goodman KA, Toner S et al (2005) Intensity modulated radiation therapy in the treatment of lymphoma involving the mediastinum. Int J Radiat Oncol Biol Phys 62:198–206PubMedCrossRefGoogle Scholar
  56. 56.
    Hoppe BS, Flampouri S, Su Z et al (2012) Effective dose reduction to cardiac structures using protons compared with 3DCRT and IMRT in mediastinal Hodgkin lymphoma. Int J Radiat Oncol Biol Phys 84(2):449–455PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2015

Authors and Affiliations

  1. 1.Department of Radiation OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Radiation OncologyStanford University Medical CenterStanfordUSA

Personalised recommendations