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In the United States RT is less commonly used in the management HL
the consequences
•
With the use of PET scans upstaging to stages III/IV is not uncommon;
hence less RT is used
•
How have radiotherapists optimized treatment?
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When administered, Radiation fields are smaller (IF-RT) and doses are lower than in past
decades
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More than 2/3 of women do not need axillary irradiation, resulting in minimal (<10%) or no
breast exposure
–
Bulk decrease by chemotherapy and the benefit of modern imaging allows further
radiation field reduction (mediastinum)
–
Radiation dose has been cut back from >40 Gy to 30 Gy and more recently to 20 Gy (50%
reduction
•
For unfavorable and bulky stage II HL too many physicians forget that the
relapse rate is higher with chemotherapy alone compared to CMT; most
failures occur in sites of previous nodal disease!
•
Most patients who fail chemotherapy alone are still HIGHLY
curable but now they need HDT
–
Can this paradigm change?