Advanced Technology Radiation Therapy with Dose Painting: Opportunities for Outcome Improvement for Management of Lymphoma

Radiation therapy remains important in the modern management of both Hodgkin and non-Hodgkin lymphoma. Radiation is applied as both consolidation therapy post chemotherapy and primary therapy for selected limited volume clinically favorable histology. Application of modern therapy techniques permits more sparing of normal tissue in all anatomical locations. Modern image guidance permits both security in daily patient treatment set up and permits strategic titration of the planning target volume to further spare normal tissue. Four-dimensional planning makes certain targets are fully treated in all phases of the breathing cycle. Dose painting with altered fractionation permits identification of low, intermediate, and high-risk areas of concern and treat each in a single plan with multiple fractionation schemes saving both time of treatment and cost of therapy. In this paper we present multiple examples of the application of modern therapy techniques in lymphoma management and demonstrate advantages of modern radiation in several anatomical regions.