Hodgkin Lymphoma (HL) is one of the most common cancers in young adult. Early stage Hodgkin disease has a good prognosis and high survival rates with modern therapeutic approaches. Clinical management of early stage HL involves two therapeutic options: one is combined modality therapy with abbreviated chemotherapy plus involved field radiation therapy (IFRT) and the other is chemotherapy alone. Combined modality ensures high cure rates but exposes young HL survivors to short-term and long-term complications such as cardiovascular and pulmonary disease and second malignancies especially in case of mediastinal involvement. Radiation therapy is crucial in the management of HL and has changed over the last decades. The introduction of new irradiation techniques such as Intensity modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT), the delivery of lower doses regimens and the reduction of field sizes from extended field radiotherapy (EFRT ) to involved field RT (IFRT) and involved –nodal RT (INRT) allow to choose the most effective and safest technique. We present a case report of a paediatric HL, stage II bulky mediastinal, already treated with different chemotherapy regimens containing bleomicyn and candidate to autologous transplantation in order to demonstrate which radiation technique is more effective and safer for lungs between 3D conformational therapy (3DCRT) and VMAT. VMAT seems safer for better lung sparing.
