The Role of Radiation Therapy in Patients With Relapsed or Refractory Hodgkin Lymphoma: Guidelines From the International Lymphoma Radiation Oncology Group

TY - JOUR

T1 - The Role of Radiation Therapy in Patients With Relapsed or Refractory Hodgkin Lymphoma

T2 - Guidelines From the International Lymphoma Radiation Oncology Group

AU - Constine, Louis S

AU - Yahalom, Joachim

AU - Ng, Andrea K

AU - Hodgson, David C

AU - Wirth, Andrew

AU - Milgrom, Sarah A

AU - Mikhaeel, N George

AU - Eich, Hans Theodor

AU - Illidge, Tim

AU - Ricardi, Umberto

AU - Dieckmann, Karin

AU - Moskowitz, Craig H

AU - Advani, Ranjana

AU - Mauch, Peter M

AU - Specht, Lena

AU - Hoppe, Richard T

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early- and advanced-stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood to maximize our success in treating these patients. The complexity of treating relapsed or refractory HL derives from the spectrum of primary treatment approaches currently in use that creates heterogeneity in both treatment exposure and the potential toxicities of salvage therapy. Patients can have relapsed or refractory disease after limited or aggressive primary therapy (with or without radiation therapy), at early or delayed time points, with limited or extensive disease volumes, and with varying degrees of residual morbidity from primary therapy. Their response to salvage systemic therapy can be partial or complete, and the use of consolidative stem cell transplantation is variably applied. New biologics and immunotherapeutic approaches have broadened but also complicated salvage treatment approaches. Through all of this, radiation therapy remains an integral component of treatment for many patients, but it must be used effectively and judiciously. The purpose of this review is to describe the different treatment scenarios and provide guidance for radiation dose, volume, and timing in patients with relapsed or refractory HL.

AB - Relapsed and refractory Hodgkin lymphoma (HL) challenges clinicians to devise treatment strategies that are effective and safe. This problem is particularly prominent in an era when de-escalation trials are designed to minimize therapeutic toxicities in both early- and advanced-stage disease. Radiation therapy is the single most effective treatment modality for HL, and its integration into salvage regimens, or its independent use in select patients, must be understood to maximize our success in treating these patients. The complexity of treating relapsed or refractory HL derives from the spectrum of primary treatment approaches currently in use that creates heterogeneity in both treatment exposure and the potential toxicities of salvage therapy. Patients can have relapsed or refractory disease after limited or aggressive primary therapy (with or without radiation therapy), at early or delayed time points, with limited or extensive disease volumes, and with varying degrees of residual morbidity from primary therapy. Their response to salvage systemic therapy can be partial or complete, and the use of consolidative stem cell transplantation is variably applied. New biologics and immunotherapeutic approaches have broadened but also complicated salvage treatment approaches. Through all of this, radiation therapy remains an integral component of treatment for many patients, but it must be used effectively and judiciously. The purpose of this review is to describe the different treatment scenarios and provide guidance for radiation dose, volume, and timing in patients with relapsed or refractory HL.

KW - Antineoplastic Agents/therapeutic use

KW - Hodgkin Disease/diagnostic imaging

KW - Humans

KW - Molecular Targeted Therapy/methods

KW - Radiation Injuries/prevention & control

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted

KW - Recurrence

KW - Salvage Therapy/methods

U2 - 10.1016/j.ijrobp.2018.01.011

DO - 10.1016/j.ijrobp.2018.01.011

M3 - Review

C2 - 29722655

SN - 0360-3016

VL - 100

SP - 1100

EP - 1118

JO - International Journal of Radiation Oncology, Biology, Physics

JF - International Journal of Radiation Oncology, Biology, Physics

IS - 5

ER -