Given the high rates of durable remissions for patients with early-stage Hodgkin’s lymphoma, the emphasis of research is now focused on minimizing toxicities while improving long-term outcomes. Traditionally, this paradigm has focused on a reduction in the use of radiation therapy, due to the associated long-term side effects. However, as new modalities have been development, renewed interest has been placed on the role of frontline radiation therapy.

The long-term toxicity of radiation therapy using current strategies is unknown, reports Anas Younes, MD. Biases toward radiation are based largely on the long-term side effects seen with the modalities used 30 years ago, which induced cardiac toxicities and secondary malignancies. However, evidence suggests that radiation therapy could play a vital role, specifically following frontline treatment with ABVD, if a complete remission has not been achieved. The use of radiation in this setting could spare patients from undergoing transplantation or other second-line therapies, notes Younes.

If possible, Andrei R. Shustov, MD, avoids the frontline administration of radiation therapy for younger patients with early-stage Hodgkin lymphoma. However, in older patients, Shustov has less reservations, since long-term side effects may not have ample time to manifest. Across the board, Shustov does not frequently administer radiation therapy.

To address cardiac and secondary malignancies, modern radiation therapy can be administered to areas of the chest and mediastinum that avoid the breast and heart, notes Steve M. Horwitz, MD. Additionally, radiation is now rarely exposed to the axilla, further lowering long-term concerns. Additionally, Horwitz explains, the fields used can be individualized on a per patient basis.