Successful role of radiation therapy: Account for every single gray and make every single gray count

Combined-modality treatment involving immuno-chemotherapy with or without radiation has become the mainstay of treatment for aggressive lymphomas such as diffuse large B-cell lymphoma (DLBCL). Long-term goals in the treatment of DLBCL are to keep improving the therapeutic ratio and to extend survival; these goals have been accomplished largely by (a) gaining insight into disease biology and developing biologically based criteria to guide choice of therapy, (b) avoiding unnecessarily long courses of chemotherapy, and (c) reducing both the size of the radiation fields and the radiation dose. Here I review the available literature on which clinical presentations can benefit the most from radiation; how the availability of advanced imaging has led to radical changes in the use of radiation therapy in DLBCL; and examples of best-practice radiation planning and delivery.