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Radiation therapy is an established form of therapy for breast cancer, often applied in an adjuvant setting delivered in a post-operative environment to volumes including the breast, surgical cavity, and regional lymph nodes when appropriate. Historically, radiation therapy has not been considered an option for care when the patient recurs with the disease despite being treated with radiation therapy in the adjuvant setting. However, there can be clinical circumstances that require a different approach to the care including comprehensive re-treatment with radiation therapy in highly selected situations. This paper reviewed two patients with clinical circumstances requiring consideration for re-treatment with radiation therapy and were successfully re-treated with an acceptable outcome.

Radiation therapy has undergone an extraordinary transformation in treatment technology. Daily patient care is vastly different today than the past with less normal tissue in the treatment field and fewer acute sequelae during and immediately post therapy. It is anticipated that modern therapy will decrease acute effects during treatment. Modern primary care physicians and internal medicine/emergency physicians will encounter more patients in their practice who are survivors of therapy. In this paper we review current expectations for clinical sequelae of management and strategies to both identify and manage treatment effects moving forward including what is needed in the medical record for evaluation of late effects.

Radiation therapy remains important in the modern management of both Hodgkin and non-Hodgkin lymphoma. Radiation is applied as both consolidation therapy post chemotherapy and primary therapy for selected limited volume clinically favorable histology. Application of modern therapy techniques permits more sparing of normal tissue in all anatomical locations. Modern image guidance permits both security in daily patient treatment set up and permits strategic titration of the planning target volume to further spare normal tissue. Four-dimensional planning makes certain targets are fully treated in all phases of the breathing cycle. Dose painting with altered fractionation permits identification of low, intermediate, and high-risk areas of concern and treat each in a single plan with multiple fractionation schemes saving both time of treatment and cost of therapy. In this paper we present multiple examples of the application of modern therapy techniques in lymphoma management and demonstrate advantages of modern radiation in several anatomical regions.

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