Novel radiotherapy techniques for involved-field and involved-node treatment of mediastinal Hodgkin lymphoma

Abstract

Further reduction of treated volumes most effectively reduces OAR dose, most likely without disadvantages if the excellent control rates achieved currently are maintained. For both IFRT and INRT, the benefits of advanced radiotherapy techniques depend on the individual patient/target geometry. Their use should therefore be decided case by case with comparative treatment planning.

Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

“…These studies are notable for observing less absolute dose reduction to OARs when comparing proton versus photon treatment plans, when just the residual disease was treated. This finding suggests that the differences in modality are less apparent with smaller field volumes, as was also reported in the review article by Lohr et al (70).…”

Comparative treatment planning study for mediastinal Hodgkin’s lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy

“…This has been achieved through reducing the prescribed dose [1,2], and the irradiated volume, by introducing the involved node radiotherapy (INRT) and involved site radiotherapy (ISRT) concepts where only the initially involved lymph nodes are included in the target [8]. Also, more advanced image guidance and conform treatment techniques, such as 3-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and helical tomotherapy, have been introduced in HL RT [9][10][11]. The dynamic treatment techniques provide a very conformal high-dose distribution, however at the expense of larger healthy tissue volumes being irradiated to low doses.…”

Optimized Volumetric Modulated Arc Therapy Versus 3D-CRT for Early Stage Mediastinal Hodgkin Lymphoma Without Axillary Involvement: A Comparison of Second Cancers and Heart Disease Risk

“…Retrospective data on clinical outcomes support the safety and efficacy of both INRT (5) and ISRT (6,7), planned with either standard 3D technique or IMRT. On the technical side, various IMRT solutions have been implemented over the years, generally showing superior target coverage and sparing of organs at risk (OAR; mainly heart and coronary arteries) (8)(9)(10). However, the heartsparing effect of IMRT at high-intermediate dose is usually achieved at the price of a larger amount of thoracic tissues receiving low or very low doses (breasts, lungs).…”