Involved-Node Radiotherapy in Early-Stage Hodgkin’s Lymphoma

Eich, Hans Theodor; Müller, Rolf-Peter; Engenhart‐Cabillic, Rita; Lukáš, Peter; Schmidberger, Heinz; Staar, Susanne; Willich, Normann

doi:10.1007/s00066-008-1882-7

Cited by 87 publications

(16 citation statements)

References 20 publications

(21 reference statements)

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“…Because of the excellent outcome of the patients with early-stage Hodgkin disease and the known risk of ionizing radiation, decreasing the treatment was performed. A decrease in the total dose was the first step [23]; the second step was the adaptation of the irradiated volume from the involved fields to the initial involved node areas [3,29,30,42-44]. A “Mantelet” field was progressively avoided.…”

Section: Discussionmentioning

confidence: 99%

Contribution of three-dimensional conformal intensity-modulated radiation therapy for women affected by bulky stage II supradiaphragmatic Hodgkin disease

et al. 2013

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PurposeTo analyze the outcome and dose distribution of intensity-modulated radiation therapy (IMRT) by helical tomotherapy in women treated for large supradiaphragmatic Hodgkin’s disease.Material and methodsA total of 13 patients received adjuvant radiation at a dose of 30 Gy to the initially involved sites with a boost of 6 Gy to those areas suspected of harboring residual disease on the simulation CT scan.ResultsWith a median follow-up of 23 months, the two-year progression-free survival was 91.6%, and the 2- and 3-year overall survivals were 100%. We did not report any heart or lung acute side effects. The conformity index of PTV (Planning Target Volume) was better for IMRT than for 3D-CRT (p=0.001). For the breasts, lungs, heart, thyroid and esophagus, the volume distributions favored the IMRT plans. For the breasts, the V20Gy, V25Gy and V30Gy were 1.5, 2.5 and 3.5 times lower, respectively, for IMRT than for 3D-CRT. For the lung tissues, the V20Gy and V30Gy were 2 times and 4.5 times lower, respectively, for IMRT than for 3D-CRT. For the heart, the V20Gy and V30Gy were 1.4 and 2 times lower, respectively, for IMRT than for 3D-CRT. For the esophagus, the V35Gy was 1.7 lower for IMRT than for 3D-CRT, and for the thyroid, the V30Gy was 1.2 times lower for IMRT.ConclusionIMRT by helical tomotherapy improved the PTV coverage and dramatically decreased the dose in organs at risk. The treatment was well tolerated, but a longer follow-up is necessary to prove a translation of these dosimetric improvements in the outcome of the patients.

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Section: Discussionmentioning

confidence: 99%

Contribution of three-dimensional conformal intensity-modulated radiation therapy for women affected by bulky stage II supradiaphragmatic Hodgkin disease

et al. 2013

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“…In July 1996, the radiotherapy policy was changed to include only the prechemotherapy involved nodes with a reduced margin: for the purposes of this study, this volume has been termed ''involved-node radiotherapy with margins up to 5 cm'' (INRT5 cm) to acknowledge and distinguish from other published definitions of INRT. 21,24 The clinical target volume (CTV) encompassed the prechemotherapy volume of disease, within postchemotherapy anatomical limits; for example, in the setting of a prechemotherapy mediastinal mass displacing the lung laterally without lung invasion, then only the width of the postchemotherapy mediastinum was included in the CTV, rather than the full prechemotherapy width of the mass. To account for physiological movement and interfraction set-up variation, non-uniform margins up to 5 cm were added to the CTV to form the planning target volume (PTV); for example, the PTV for mediastinal and hilar nodes required a larger superior-inferior margin to account for the greater range of respiratory motion in these directions.…”

Section: Radiotherapymentioning

confidence: 99%

Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy

Campbell

Connors

Gascoyne

et al. 2012

Cancer

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BACKGROUND: For limited-stage diffuse large B-cell lymphoma (DLBCL), treatment decisions are often influenced by toxicity profiles. One strategy that minimizes chemotherapy-induced toxicities is abbreviated chemotherapy plus consolidation involved-field radiotherapy (IFRT). Involved-node radiotherapy (INRT) is a new concept to DLBCL, aimed to reduce radiotherapy-induced toxicities. We retrospectively review the long-term outcomes of limited-stage DLBCL treated with abbreviated systemic therapy and radiotherapy focusing on field size: IFRT versus INRT. METHODS: The British Columbia Cancer Agency Lymphoid Cancer Database was used to identify patients diagnosed with limited-stage DLBCL (stage I/II, without B-symptoms; bulk < 10 cm) from 1981 to 2007. Patients were prescribed 3 cycles of chemotherapy plus IFRT (1981-1996) or INRT5 cm (1996, defined as INRT to the prechemotherapy involved nodes with margins 5 cm. RESULTS: A total of 288 patients were identified: 56% were aged >60 years, 34% had stage II disease, 55% had extranodal disease, 19% had elevated lactate dehydrogenase levels, and 15% received rituximab. The two radiotherapy groups were IFRT (138 patients; 48%) and INRT5cm (150 patients; 52%); median follow-up was 117 and 89 months, respectively. Distant relapse was the most common site of failure in both groups. After INRT5 cm, marginal recurrence was infrequent (2%). Time to progression (P ¼ .823), progression-free survival (P ¼ .575), and overall survival (P ¼ .417) were not significantly different between the radiotherapy cohorts. Radiotherapy field size was not a significant prognostic factor on multivariate analyses. CONCLUSIONS: This research is the first known body of work to apply the concept of INRT to limited-stage DLBCL. Reducing the field size from IFRT to INRT5 cm maintains a low marginal recurrence risk with no impact on overall outcome. Cancer 2012;118:4156-65.

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“…Per EORTC-GELA guidelines, the clinical target volume should include only the site of originally involved lymph nodes identified prior to chemotherapy [16]. Controversy exists regarding the optimal margins in INRT field design, with groups using different definitions[17–19]. The appropriate design of INRT fields is an open question, with U.S. and European protocols having variable designations of the radiation field that INRT should encompass [16,18,19].…”

Section: Radiation Treatment Field Designmentioning

confidence: 99%

“…Controversy exists regarding the optimal margins in INRT field design, with groups using different definitions[17–19]. The appropriate design of INRT fields is an open question, with U.S. and European protocols having variable designations of the radiation field that INRT should encompass [16,18,19]. Therefore, it is important to delineate the INRT field according to the specific protocol being followed.…”

Section: Radiation Treatment Field Designmentioning

confidence: 99%

“…Although no marginal recurrences were identified after INRT, the margins for INRT used in this study were tantamount to a reduced IFRT field. INRT as defined by the EORTC-GELA and GHSG uses significantly smaller margins [16,19]. INRT as defined by the EORTC-GELA encompasses the initially involved volume with a margin for uncertainty.…”

Section: Radiation Treatment Field Designmentioning

confidence: 99%

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Tailored strategies for radiation therapy in classical Hodgkin's lymphoma

Terezakis

Kasamon

2012

Critical Reviews in Oncology/Hematology

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Involved-Node Radiotherapy in Early-Stage Hodgkin’s Lymphoma

Abstract: The concept of IN radiotherapy has been proposed as a means to further improve the therapeutic ratio by reducing the risk of radiation-induced toxicity, including second malignancies. Field sizes wiLL further decrease compared to IF radiotherapy.

Cited by 87 publications

References 20 publications

Contribution of three-dimensional conformal intensity-modulated radiation therapy for women affected by bulky stage II supradiaphragmatic Hodgkin disease

Contribution of three-dimensional conformal intensity-modulated radiation therapy for women affected by bulky stage II supradiaphragmatic Hodgkin disease

Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy

Tailored strategies for radiation therapy in classical Hodgkin's lymphoma

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