Advanced Stage Hodgkin and Diffuse Large B-Cell Lymphomas: Is There Still a Role for Consolidation Radiotherapy in the PET Era?

• Published in: Seminars in radiation oncology 2025-01, Vol.35 (1), p.16-26
• Main Authors: Levis, Mario, Oertel, Michael
• Format: Article
• Language: English
• Subjects: Fluorodeoxyglucose F18; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; Lymphoma, Large B-Cell, Diffuse - diagnostic imaging; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - radiotherapy; Neoplasm Staging; Positron-Emission Tomography - methods; Radiotherapy, Image-Guided - methods
• ISSN: 1053-4296; 1532-9461; 1532-9461
• DOI: 10.1016/j.semradonc.2024.07.013

The role of radiotherapy in the treatment of lymphoma is rapidly evolving. The development of modern systemic therapies and the adoption of FDG-PET-scanning as metabolic prognosticators are leading to a process of refinement of the treatment regimens. In this scenario, radiotherapy utilization is decreasing in several settings, including lower risk patients, to prevent the risk of long-term complications. Over the last decade, the most relevant changes in the treatment landscape are evident for advanced stage Hodgkin lymphoma and diffuse large B cell lymphoma. The main purpose of this paper is to review radiotherapy indications in these settings, to highlight pros and cons of a PET-guided strategy for radiotherapy recommendations, and to introduce future perspectives on the combination of radiotherapy and modern systemic therapies in both frontline and relapsed setting of advanced stage Hodgkin and diffuse large B cell lymphomas.