Reappraisal of the role of radiation therapy in lymphoma treatment

Abstract

Radiation therapy (RT) for lymphomas has improved dramatically with modern imaging and treatment techniques, encompassing only the necessary volume with minimal doses to normal structures. Prescribed radiation doses are reduced, and fractionation schedules are under revision. With effective systemic treatment only initial macroscopic disease is irradiated. With no or less effective systemic treatment, possible microscopic disease is also included. Risks of long‐term side effects of RT have diminished dramatically and should be weighed against risks from more systemic treatment or increased risk of relapse. Lymphoma patients are often elderly, they tolerate modern limited RT very well. Lymphomas refractory to systemic treatments often remain radioresponsive, and brief, mild RT may offer effective palliation. New roles for RT are emerging with immune therapies. RT for “bridging,” keeping the lymphoma under control while waiting for immune therapy, is well established. Enhancement of the immune response to lymphomas, so‐called “priming,” is being intensively researched.

Stable use of radiotherapy in lymphoma patients over time – A comprehensive national overview of radiotherapy use in Sweden with focus on older patients

“…RT is associated with a risk of long-term side effects, especially following historical protocols with large extended RT fields [1] , [2] , [3] , [4] . More advanced techniques that enable treatment of larger target volumes with lower radiation doses have reduced this risk [5] , [6] , [7] . Implementation of involved site radiation therapy (ISRT) has also contributed to decreased toxicity of RT [8] , [9] as has novel RT modalities such as volumetric modulated arc therapy (VMAT) and proton radiotherapy [7] .…”

“…More advanced techniques that enable treatment of larger target volumes with lower radiation doses have reduced this risk [5] , [6] , [7] . Implementation of involved site radiation therapy (ISRT) has also contributed to decreased toxicity of RT [8] , [9] as has novel RT modalities such as volumetric modulated arc therapy (VMAT) and proton radiotherapy [7] . Concomitantly, more effective and tolerable novel agents and chemoimmunotherapy (CIT) regimens are being developed, potentially leading to decreased use of RT for many lymphoma subtypes.…”