Treatment Guideline Chart

Hodgkin's lymphoma is a malignancy that arises from germinal center B cell.

Histologically, there is a presence of multinucleated giant cells in a mixed inflammatory background.

It is also known as Hodgkin's disease, Hodgkin lymphoma or Hodgkin disease.

It commonly affects individuals ages 15-30 years old and those 55 years old and above.

The key morphologic characteristics include presence of Reed-Sternberg cells and lymphocyte-predominant cells.

Hodgkin's%20lymphoma Treatment


  • Advanced RT delivery techniques such as intensity-modulated RT (IMRT), volumetric modulated arc therapy (VMAT), breath hold or respiratory gating, image-guided RT (IGRT), proton therapy should be considered in special cases where radiation exposure of specific organs are reduced while achieving the primary goal of local tumor control

Involved-Site Radiation Therapy (ISRT)

  • Radiation aimed directly at the lymph nodes containing the Hodgkin's lymphoma
    • May also target nearby structures
  • Concentrated on the involved node and extranodal extensions, reducing the field exposed to radiation, thereby sparing other organs from unnecessary radiation exposure
  • Recommended primary therapy for patients with NLPHL stage IA/IIA
  • Used in combination with chemotherapeutic regimens with or without Rituximab in patients with NLPHL clinical stage IB/IIB or bulky NLPHL clinical stage IA/IIA
  • Also recommended for patients with NLPHL clinical stage IIIA/IVA and IIIB/IVB with or without chemotherapeutic regimens and Rituximab
  • Not to be used for high cervical regions and axillae in women
  • Recommended doses:
    • Combined modality therapy
      • 20-30 Gy (when treated with ABVD) for stage I-II non-bulky disease
      • 30 Gy for stage IB-IIB non-bulky disease
      • 30-36 Gy for bulky diseases in all stages
      • 36-45 Gy for sites of partial response to chemotherapy
  • ISRT alone (rare, except for NLPHL)
    • 30-36 Gy in involved regions
    • 25-30 Gy in uninvolved regions

Involved-Field Radiation Therapy (IFRT)

  • Technique that aims at the lymph node regions with Hodgkin's lymphoma
  • Affects larger areas compared to involved-site radiation therapy, exposing nearby organs to unnecessary radiation doses
  • May be used for favorable CHL but depending on the treatment site
  • Doses of 30-36 Gy is also be used for stage I-II NLPHL and stage III-IV bulky CHL 

Palliative Radiation Therapy

  • May be given to advanced NLPHL patients with bulky disease
  • May help alleviate discomfort and pain via disease regression
  • Doses of 4-30 Gy is recommended
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