Radiotherapy treatment planning for the non-Hodgkin's lymphomas

Differences exist in the patterns of disease presentation and recurrence between Hodgkin's disease and the non-Hodgkin's lymphomas. The more frequent involvement of mesenteric nodes, Waldeyer's ring, and bone marrow, the less-frequent involvement of the mediastinum, and the fact that failures are less consistent with contiguous spread all must impact on the planning of therapy for the non-Hodkin's diseases. While the radiotherapy techniques derive from those used for Hodgkin's disease, the clinical differences substantially influence the extent of irradiation, several of the field shapes and the blocking techniques within fields determining the final distribution of doses. Appropriate primary radiotherapy for the non-Hodgkin's lymphomas varies greatly with the histologic subtype, as well as the extent, distribution and bulk of disease, and the age, physical condition and motivation of the patient. This discussion will present selected cases treated in the Stanford Division of Radiation Therapy between the years 1977 and 1986 which illustrate treatment fields and allow review of the planning techniques involved. The working formulation of non-Hodgkin's lymphomas will be used to group the histologic subtypes into histologic grades, as different radiotherapy techniques are often appropriate for each