Dosimetric Comparison of Three Different Involved Nodal Irradiation Techniques for Stage II Hodgkin's Lymphoma Patients: Conventional Radiotherapy, Intensity-Modulated Radiotherapy, and Three-Dimensional Proton Radiotherapy

Chera, Bhishamjit S.; Rodriguez, C.; Morris, Christopher G.; Louis, Debbie; Yeung, Daniel; Li, Zuofeng; Mendenhall, Nancy P.

doi:10.1016/j.ijrobp.2008.12.048

Cited by 107 publications

(65 citation statements)

References 34 publications

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“…Further follow-up will also be necessary to determine the long-term morbidity and mortality of combined modality programs in other trials with reduced chemotherapy and in more recent trials with further reduced "involved-nodal RT." 35,36 Chemotherapy alone is an alternative to combined modality therapy for nonbulky early-stage HL, which reduces the risk of late morbidity and mortality associated with RT. 3,[26][27][28] The AVG regimen attempted to reduce pulmonary toxicity by omitting bleomycin.…”

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confidence: 99%

Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET

Straus

Johnson

LaCasce

et al. 2011

Blood

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To reduce doxorubicin, bleomycin, vinblastine and dacarbazine toxicity, the Cancer and Leukemia Group B conducted a phase 2 trial of doxorubicin, vinblastine, and gemcitabine for newly diagnosed, nonbulky stages I and II Hodgkin lymphoma. Ninety-nine assessable patients received 6 cycles of doxorubicin 25 mg/ m 2 , vinblastine 6 mg/m 2 , and gemcitabine 800 mg/m 2 (1000 mg/m 2 in first 6) on days 1 and 15 every 28 days. Computed tomography (CT) and positron emission tomography (PET) were performed before and after 2 and 6 cycles. Complete remission (CR)/CR unconfirmed was achieved in 72 of 99 patients (72.7%) and partial remission in 24 of 99 patients (24.2%). The CR rate was 81% when using PET criteria. Two patients have died of Hodgkin lymphoma progression. Median follow-up for nonprogressing patients is 3.3 years. The progression-free survival (PFS) at 3 years was 77% (95% confidence interval, 68%-84%). The relapse rate was less than 10% for patients with favorable prognostic factors. The 2-year PFS for cycle 2 PETnegative and -positive patients was 88% and 54%, respectively (P ‫؍‬ .0009), compared with 89% and 27% for cycle 6 PETnegative and -positive patients (P ‫؍‬ .0001). Although the CR rate and PFS were lower than anticipated, patients with favorable prognostic features had a low rate of relapse. Cycle 2 PET and cycle 6 PET were predictive of PFS. This clinical trial is registered at www.clinicaltrials.gov as #NCT00086801. IntroductionMost patients with early-stage Hodgkin lymphoma (HL) are cured with treatment strategies, including radiation therapy (RT), chemotherapy such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), or combined modality treatment, 1 with relatively similar results. 2,3 Thus, the current challenge is to maintain excellent treatment results while reducing the serious and potentially life-threatening early and late toxicities. RT has been the major cause of late morbidity and mortality related to treatment. [4][5][6] Pulmonary toxicity from bleomycin has been the major cause of acute toxicity and rare mortality with ABVD. 2,7 Gemcitabine is one of the most active single agents for relapsed and refractory HL with response rates of 39% to 43%. 8,9 An impressive overall response rate of 70% with 19% complete remissions (CRs) was achieved in a Cancer and Leukemia Group B (CALGB) phase 2 trial of gemcitabine combined with vinorelbine and pegylated liposomal doxorubicin. 10 Based on these results, CALGB conducted a phase 2 trial of a variant of ABVD, doxorubicin, vinblastine, and gemcitabine (AVG), for newly diagnosed patients with stage I and II nonbulky classic HL in which gemcitabine replaced bleomycin, and dacarbazine was omitted because of the limited phase 2 data documenting its activity. 11 The goal was to assess the CR rate and progression-free survival (PFS) of AVG without RT with an attempt to reduce acute and long-term toxicity. A secondary objective was to evaluate positron emission tomography (PET) in predicting outcome after 2 cycles of AVG and at the completi...

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confidence: 99%

Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET

Straus

Johnson

LaCasce

et al. 2011

Blood

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“…Multiple dosimetric factors that define the shape of the DVH should be considered integrated, rather than a single factor. Indeed, with the use of more conformal techniques for lymphoma patients, 2 , 13 , 22 the acute and long‐term pulmonary toxicities associated with higher V5 and lower V20 should be elucidated in future.…”

Section: Discussionmentioning

confidence: 99%

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

Chen

Jin

Wang

et al. 2012

J Applied Clin Med Phys

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The purpose of this study is to apply noncoplanar intensity‐modulated radiation therapy (Nonco_IMRT) to young female patients with mediastinal lymphoma. Nonco_IMRT was evaluated through a planning comparison study with coplanar IMRT (Co_IMRT) and conventional anteroposterior and posteroanterior fields (AP–PA) plans. Co_IMRT was performed with five equally spaced beams starting from a gantry angle of 216°. Nonco_IMRT used two noncoplanar beams in the sagittal plane to replace the Co_IMRT beams that directly irradiated the breasts. Nineteen young female patients were enrolled in the retrospective study. Dose coverage of the planning target volume (PTV) and the dose delivered to organs at risk (OARs) were analyzed. For all patients, PTV coverage and heart V30 were similar between the two IMRT techniques (p < 0.05). Compared to Co_IMRT, the mean dose delivered and regions receiving a low radiation dose were significantly reduced for bilateral breasts and lungs in Nonco_IMRT (p < 0.05). Breast V5 and lung V5 were relatively reduced by 21% and 12%, respectively. Compared with the conventional AP–PA plan, Nonco_IMRT had better PTV coverage and OARs sparing, except for being larger in V5 to breast and lung. In IMRT for young female patients with mediastinal lymphoma, using of Nonco_IMRT significantly reduces the radiation dose to the breasts and lungs compared with Co_IMRT, and consequently reduces the risk of breast second cancer and pulmonary toxicity. Besides young female patients, Nonco_IMRT can also benefit other mediastinal lymphoma patients.PACS number: 87.55.D‐

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“…Although speculative, these considerations should promote caution when interpreting results of single-site evaluations of new technologies, such as conformal, intensity-modulated, stereotactic body, and proton RT. 55,56 At the level of individual practitioner and patient decision-making, it is important to understand the experience of the treatment center in administering RT to patients with Hodgkin lymphoma, especially if new technologies are implemented.…”

Section: The Treatment Of Limited-stage Hodgkin Lymphoma: a Hematologmentioning

confidence: 99%

Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

Meyer

Hoppe

2012

Blood

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Dosimetric Comparison of Three Different Involved Nodal Irradiation Techniques for Stage II Hodgkin's Lymphoma Patients: Conventional Radiotherapy, Intensity-Modulated Radiotherapy, and Three-Dimensional Proton Radiotherapy

Cited by 107 publications

References 34 publications

Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET

Doxorubicin, vinblastine, and gemcitabine (CALGB 50203) for stage I/II nonbulky Hodgkin lymphoma: pretreatment prognostic factors and interim PET

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

Point/counterpoint: early-stage Hodgkin lymphoma and the role of radiation therapy

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