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Reappraisal of the role of radiation therapy in the management of Hodgkin's lymphoma with large intrathoracic masses.

Patients diagnosed as having Hodgkin's lymphoma with large intrathoracic masses are nowadays generally treated with a combination of chemotherapy and radiation therapy. This approach is usually indicated for more advanced stages and for cases with extranodal extension and presentation. However, the same policy is often implemented even in patients with early stage disease whenever they present with voluminous mediastinal and/or hilar masses. Especially in young persons, this approach to treatment has life-long lasting repercussions on both their general health and social fulfillment. In this article, an alternative approach is suggested. It consists of protracted, high-dose radiation therapy to the large tumor masses using the shrinking field technique and with a dose in the range of 50 to 60 Gy delivered over an approximately 3-month period. This proposition is based on the author's clinical experience and is documented in the article.