Figure 1.

Evolution of RT in HL

(A) Schematic representation of field design, radiation therapy (RT) doses, and radiation techniques for adult Hodgkin lymphoma (HL) as they have evolved over time. (B, C) RT plan comparison of an HL patient treated with involved-site RT to the mediastinum including colorwash dose distribution. Recreated historical mantle field (B), anterior-posterior technique, treated to a dose of 40 Gy, versus involved-site RT using IMRT (C), with deep-inspiration breath hold (note expansion of lungs and elongation of mediastinal structures, displacing lungs and heart away from target volume) with arms down on inclined board (further displacement of heart inferiorly), treated to 30 Gy with a 6-Gy boost to a level 5 node. (D) Dosimetric comparison of plans in B and C. IMRT = intensity-modulated radiation therapy; LAD = left anterior descending artery; LV = left ventricle; PET-CT = positron emission tomography–computed tomography.