Dosimetric Benefits of Intensity-Modulated Radiotherapy Combined With the Deep-Inspiration Breath-Hold Technique in Patients With Mediastinal Hodgkin's Lymphoma

High-dose-rate Three-dimensional Conformal Radiotherapy Combined with Active Breathing Control for Stereotactic Body Radiotherapy of Early-stage Non-small-cell Lung Cancer

“…It reduces the lung density by expanding the lung volume, which could be beneficial for radiotherapy of lung carcinoma (22). The mDIBH approach provided greater protection to normal lungs and OARs, and it has been demonstrated to be safe and feasible for radiotherapy of breast cancers and lymphomas (26)(27)(28).…”

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

“…26,27 These techniques offer significant and clinically relevant advantages in specific instances to spare OARs and decrease the risk of normal tissue damage and late effects without compromising the primary goal of local tumor control. [28][29][30][31][32][33][34] Randomized prospective studies to test these concepts are unlikely to be conducted because these techniques are designed to decrease late effects, which usually develop ≥10 years after completion of treatment. Therefore, the guidelines recommend that RT delivery techniques that are found to best reduce the doses to the OARs in a clinically meaningful manner without compromising target coverage should be considered in these patients, who are likely to have long life expectancies after treatment.…”

“…In the experimental arm, patients were treated with 2 cycles of ABVD, underwent interim PET scans, and, if found to be PETnegative, were treated with an additional 4 cycles of ABVD. If patients were found to be PET-positive after the initial 2 cycles of ABVD, chemotherapy was intensified with 2 cycles of escalated BEACOPP with INRT (30)(31)(32)(33)(34)(35)(36). Although interim analysis demonstrated that chemotherapy alone is a viable treatment option, PET scans showed that combined modality therapy (ABVD + INRT) resulted in fewer early progressions compared with treatment with ABVD alone.…”

Contemporary Radiation Therapy in Combined Modality Therapy for Hodgkin Lymphoma

“…The potential for IMRT to decrease the dose to the heart and lungs in the setting of mediastinal RT has been demonstrated and is illustrated in Figure 2. [24][25][26] Nevertheless, use of IMRT should be individualized to the specific patient. As also shown in Figure 2, IMRT plans can sometimes expose a larger volume of normal tissue to low doses of radiation compared with conventional treatment plans because of the use of multiple beams with IMRT, an issue that could impact the long-term risk of secondary malignancies.…”

“…Dosimetric analysis has confirmed a decreased mean dose to key thoracic structures with use of DIBH when compared with free-breathing, particularly in the context of IMRT. 24 Proton therapy may also provide additional dosimetric benefit, given its ability to reduce exit dose. In a prospective phase II trial of proton therapy using INRT for patients with mediastinal HL, the mean heart and lung doses were significantly reduced, compared with 3-dimensional conformal and IMRT plans.…”