Can low-risk, early-stage patients with Hodgkin lymphoma be spared radiotherapy?

Advances in the treatment of Hodgkin lymphoma since about 1970 have led to a remarkable improvement in the long-term outcomes of what was once considered an incurable disease. The prolonged survival of cured patients has revealed new issues concerning the toxicity of successful therapy, however, including an increased risk of secondary malignancies and end-organ damage such as heart disease. This concern has led to the clinical research question of whether the de-escalation of treatment intensity could allow high cure rates to continue with less long-term toxicity. In young patients with favorable early-stage disease, the challenge has been to use systemic therapy while omitting radiation therapy as part of the initial treatment. This review briefly summarizes past data and updates readers regarding recent publications on this topic.