Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy

被引:48
作者
Campbell, B. A. [1 ]
Hornby, C. [2 ]
Cunninghame, J. [2 ]
Burns, M. [2 ]
MacManus, M. [1 ]
Ryan, G. [1 ]
Lau, E. [3 ,4 ]
Seymour, J. F. [5 ,6 ]
Wirth, A. [1 ]
机构
[1] Peter MacCallum Canc Ctr, Dept Radiat Oncol & Canc Imaging, Melbourne, Vic, Australia
[2] Peter MacCallum Canc Ctr, Dept Radiotherapy, Melbourne, Vic, Australia
[3] Peter MacCallum Canc Ctr, Ctr Canc Imaging, Melbourne, Vic, Australia
[4] Univ Melbourne, Dept Radiol, Parkville, Vic 3052, Australia
[5] Peter MacCallum Canc Ctr, Dept Haematol, Melbourne, Vic, Australia
[6] Univ Melbourne, Dept Med, Parkville, Vic 3052, Australia
关键词
dosimetry; Hodgkin lymphoma; INRT; involved node radiotherapy; organs at risk; toxicity; BREAST-CANCER RISK; RADIATION-THERAPY; 2ND MALIGNANCY; DISEASE; CHEMOTHERAPY; FIELD; REDUCTION; MORTALITY; SURVIVORS;
D O I
10.1093/annonc/mdr439
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Chemotherapy plus radiotherapy is the standard of care for patients with limited stage Hodgkin lymphoma (HL). Radiotherapy is evolving from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) to decrease radiotherapy-related morbidity. In the absence of long-term toxicity data, dose-volume metrics of organs at risk (OAR) provide a surrogate measure of toxicity risk. Ten female patients with stage I-IIA supradiaphragmatic HL were randomly selected. All patients had pre-chemotherapy computerised tomography (CT) and CT-positron emission tomography staging. Using CT planning, three radiotherapy plans were produced per patient: (i) IFRT, (ii) INRT using parallel-opposed beams and (iii) INRT using volumetric modulated arc therapy (VMAT). Radiotherapy dose was 30.6 Gy in 1.8 Gy fractions. OAR evaluated were lungs, breasts, thyroid, heart and coronary arteries. Compared with IFRT, INRT significantly reduced mean doses to lungs (P < 0.01), breasts (P < 0.01), thyroid (P < 0.01) and heart (P < 0.01), on Wilcoxon testing. Compared with conventional INRT, VMAT improved dose conformality but increased low-dose radiation exposure to lungs and breasts. VMAT reduced the heart volume receiving 30 Gy (V30) by 85%. Reduction from IFRT to INRT decreased the volumes of lungs, breasts and thyroid receiving high-dose radiation, suggesting the potential to reduce long-term second malignancy risks. VMAT may be useful for patients with pre-existing heart disease by minimising further cardiac toxicity risks.
引用
收藏
页码:1259 / 1266
页数:8
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