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Radiation therapy of the neck region and supraclavicular fossa for malignant lymphoma



In the Ann Arbor classification system, the neck with the ipsilateral and supraclavicular fossae are one region. In radiation therapy, it is in many cases natural to separate the upper neck region, lower neck region, and supraclavicular fossa on each side from each other. Thus, for example, when treating Waldeyers ring and no involved lymph nodes, it is correct to include the upper neck region with submental, submandibular, and occipital nodes to have an adequate margin in the caudal direction.  When treating the mediastinum, it is important to include the supraclavicular fossa bilaterally to have adequate margins to the tumor to be irradiated. Also, sometimes the supraclavicular fossa and infraclavicular fossa on the same side must be included when the axilla is irradiated. 

Curative radiation therapy

  • For localized stages of classical Hodgkin's lymphoma (stage IA/IIA), radiation therapy is given to the original area involved with margin (involved field) after chemotherapy (ABVD or equivalent).
  • For localized stages of nodular lymphocyte-rich Hodgkin's lymphoma (stage IA/IIA) without risk factors, radiation therapy alone is given to the involved area with margin (involved field) without previous chemotherapy.
  • Special guidelines apply for children and adolescents up to 18 years with Hodgkin's lymphoma. 
  • For residual tumor of Hodgkin's lymphoma after full chemotherapy for advanced Hodgkin's lymphoma (6-8 ABVD, 8 BEACOPP or equivalent), consolidative radiation therapy to the residual tumor with margin is considered.  
  • For localized stages of aggressive lymphomas (stage I-II1), consolidative radiation therapy after chemotherapy (CHOP-based or equivalent) to the original tumor-involved area with margin (involved field) is given.
  • With residual tumor of aggressive lymphomas after full chemotherapy (6-8 CHOP-based cycles or equivalent), consolidative radiotherapy to the residual tumor with margin is considered. 
  • For indolent lymphomas with localized disease (stadium I-II1), radiation therapy alone is given to the involved area with margin (involved field).

Palliative radiation therapy

As palliative radiation therapy, the method is based on guidelines for curative treatment with individual modifications.




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