Does radiotherapy still have a place in Hodgkin lymphoma?

Over half a century, radiation therapy (RT) for Hodgkin lymphoma has been transformed from a radical, extensive, high-dose therapy (which alone cured most patients) into an essential component of a comprehensive combined-modality program. RT is now used in a "mini" version that encompasses only the clinically involved sites following chemotherapy and is administered in a markedly reduced dose. This change has considerably reduced the long-term complications that were associated with the now-outdated radical RT approach. The use of RT also allows a shorter and safer course of chemotherapy. The combination of reduced chemotherapy followed by mini-RT has produced disease control and even overall results that are significantly superior to those achieved with chemotherapy alone. This review discusses controversial issues regarding RT, the studies that have addressed them, the new indications for integrating RT, and the safety of minimizing the radiation field and dose.