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Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):49-58. doi: 10.1016/j.ijrobp.2014.01.006.

Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group.

Author information

  • 1Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom. Electronic address: Tim.Illidge@ics.manchester.ac.uk.
  • 2Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • 3Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
  • 4Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • 5Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  • 6Departments of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York.
  • 7Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  • 8Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts.
  • 9Radiation Oncology Unit, Department of Oncology, University of Torino, Torino, Italy.
  • 10Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne, Australia.


Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.

Copyright © 2014 Elsevier Inc. All rights reserved.

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