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

Abstract

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.

Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks

“…With regard to cardiac doses, dose or volume dependence for late toxicity remains unclear [29]. Other studies [18,24] have also included the proximal coronary arteries as a possible region that may relate to late complications; we were not able to reliably contour this region with our scan data/phase of contrast/experience. Campbell et al [18] found that although INRT offered a reduction in whole heart doses, the dose to proximal coronary arteries was not reduced.…”

“…Other studies [18,24] have also included the proximal coronary arteries as a possible region that may relate to late complications; we were not able to reliably contour this region with our scan data/phase of contrast/experience. Campbell et al [18] found that although INRT offered a reduction in whole heart doses, the dose to proximal coronary arteries was not reduced. Data from Paumier et al [24] suggests that additional techniques, such as deep inspiratory breath hold, are required to reduce the dose to the proximal coronary arteries.…”

“…For the purposes of this study all radiotherapy was planned with a parallel-opposed pair technique. There may be potential to use techniques including three-dimensional conformal and intensity-modulated radiotherapy (IMRT) techniques [18,20] for selected patients; the dosimetric and second malignancy calculations are technique dependent. Studies have consistently shown that IMRT techniques can reduce mean doses to OARs [20,30,31].…”

Pediatric Hodgkin lymphoma: trade-offs between short- and long-term mortality risks

“…Modern therapies, such as involved field radiotherapy, may reduce the long-term secondary malignancy risk from radiation treatments and protect the heart and coronary arteries by reducing mean radiation dose to the heart. 29 By limiting normal tissue exposure, these methods may be more important than total dose in terms of risk of long-term toxicities. 30 As late-effects mortality data on survivors treated more recently will not be available for many years, our model provides important insight by leveraging the best available clinical data now, and suggests that if involved field radiation reduces CRT excess cardiac risk by 50% or eliminates CRT excess second cancer risk all together, CT would still be associated with more favorable OS.…”

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

“…21 Dosimetric studies demonstrate that reducing the radiotherapy field from IFRT to INRT significantly reduces the radiation dose to lungs, breast, and thyroid. 29,30 Using dosimetric parameters as surrogate endpoints for toxicity, it is reasonable to extrapolate that these dose reductions are likely to translate into lower risks of radiation-induced toxicities and second malignancies in long-term survivors. Our group has retrospectively evaluated the impact of reduced radiotherapy field sizes on patterns of relapse and survival in limited-stage Hodgkin lymphoma and follicular lymphoma.…”