Role of Radiotherapy in Advanced Stage Hodgkin Lymphoma With Bulky Disease: A Systematic Review and Meta‐Analysis

Background and Purpose: Hodgkin lymphoma (HL) is an uncommon malignancy predominantly affecting young adults. Chemotherapy is the main treatment, with radiotherapy used selectively in early‐stage disease. This meta‐analysis evaluates the impact of adding radiotherapy to bulky disease sites in advanced‐stage HL patients who achieve complete remission (CR) after chemotherapy. Materials and Methods Studies comparing radiotherapy versus no further local treatment in advanced HL (Stages IIB–IV) after CR were included. The primary endpoint was progression‐free survival (PFS). Effect estimates were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results Five studies published between 1994 and 2022, including 1083 patients (555 radiotherapy; 528 no radiotherapy), met inclusion criteria. The median age was approximately 31 years in both groups. Median follow‐up across studies was 71 months. Various chemotherapy regimens were used, most commonly ABVD. Patients receiving radiotherapy had significantly improved PFS compared with those not receiving radiotherapy (OR = 1.63; 95% CI = 1.07–2.48; p = 0.02). Conclusion Radiotherapy to bulky sites in advanced HL patients who achieve CR following chemotherapy is associated with better PFS compared with no additional treatment. Further research is needed to clarify how radiation dose and technique influence PFS and long‐term outcomes. Trial Registration: This meta‐analysis was designed according to the guidelines of the 2009 Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) statement and was registered in the PROSPERO database (CRD42024593942).