Radiotherapy for non-Hodgkin's lymphoma. Important again?

Radiotherapy is highly efficient for the treatment of lymphoma. The results of recent studies support the value of involved site radiotherapy (ISRT) within the current curative multimodal treatment strategies. To summarize the current evidence and the methods for administration of radiotherapy in the multimodal treatment of non-Hodgkin's lymphoma (NHL). A Medline search was undertaken using the key words "lymphoma and radiotherapy" between January 2005 and May 2015. Reviews and original articles with results which led to a change in practice were considered for this review. In aggressive lymphoma all sites with initial bulky disease or extranodal spread should be treated with 40 Gy ISRT. Future studies should evaluate whether a dose reduction to 30 Gy would be possible. In patients older than 60 years with bulky disease or extranodal spread the ISRT might be confined to cases with residual lymphoma after chemotherapy which are positive in positron emission tomography (PET). Indolent lymphomas in stage I or II should be treated in curative intention with ISRT with wider margins and also known as involved field for follicular lymphoma (IF-FL). The recommended doses are between 24 and 30 Gy. Palliative treatment of indolent lymphoma is very efficient with low radiation doses of 2 x 2 Gy. In cases of extranodal disease radiotherapy should always be considered and discussed in multidisciplinary conferences. Doses and target volumes for extranodal lymphoma may be subject to change as soon as the results of currently running studies become available. Radiotherapy should always be considered as a curative treatment option for adult patients with lymphoma. Treatment decisions should be taken in a multidisciplinary setting. Modern techniques of radiotherapy are 3-D based and mostly administered in cases of initial lymphoma spread in the form of ISRT.