Applications of new irradiation modalities in patients with lymphoma: Promises and uncertainties.

New highly conformal irradiation modalities have emerged for treatment of Hodgkin lymphoma. Helical tomotherapy offers both intensity-modulated irradiation and accurate patient positioning and was shown to significantly decrease radiation doses to the critical organs. Here we review some of the most promising applications of helical tomotherapy in Hodgkin disease. By decreasing doses to the heart or the breast, helical tomotherapy might decrease the risk of long-term cardiac toxicity or secondary breast cancers, which are major concerns in patients receiving chest radiotherapy. Other strategies, such as debulking radiotherapy prior to stem cell transplantation or total lymphoid irradiation may be clinically relevant. However, helical tomotherapy may also increase the volume of tissues that receive lower doses, which has been implicated in the carcinogenesis process. Prospective assessments of these new irradiation modalities of helical tomotherapy are required to confirm the potential benefits of highly conformal therapies applied to hematological malignancies.