Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG)

Specht, Lena; Yahalom, Joachim; Illidge, Tim; Berthelsen, Anne Kiil; Constine, Louis S.; Eich, Hans Theodor; Girinsky, T.; Hoppe, Richard T.; Mauch, Peter; Mikhaeel, N. George; Ng, Andrea K.

doi:10.1016/j.ijrobp.2013.05.005

Cited by 475 publications

(329 citation statements)

References 24 publications

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“…The clinical target volumes (CTVs) were delineated according to the International Lymphoma Radiation Oncology Group guidelines [13,14] by the same attending physician, and were expanded based on their interphase displacements to generate the internal target volumes (ITVs). Explicitly, the ITVs were constructed from the union of CTVs from all motion phases of 4D-CTs.…”

Section: Treatment Planningmentioning

confidence: 99%

Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

et al. 2016

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Background: Modern radiotherapy (RT) for lymphoma is highly personalized. While advanced imaging is largely employed to define limited treatment volumes, the use of proton pencil beam scanning (PBS) for highly conformal lymphoma RT is still in its infancy. Here, we assess the dosimetric benefits and feasibility of PBS for mediastinal lymphoma (ML). Materials and methods: Ten patients were planned using PBS for involved-site RT. The initial plans were calculated on the average four-dimensional computed tomography (4D-CT). PBS plans were compared with 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and proton double scattering (DS). In order to evaluate the feasibility of PBS and the plan robustness against interand intra-fractional uncertainties, the 4D dose was calculated on initial and verification CTs. The deviation of planned dose from delivered dose was measured. The same proton beamline was used for all patients, while another beamline with larger spots was employed for patients with large motion perpendicular to the beam. Results: PBS provided the lowest mean lung dose (MLD) and mean heart dose (MHD) for all patients in comparison with 3D-CRT, IMRT, and DS. For eight patients, internal target volume (ITV) D 98% was degraded by <3%; and the MLD and MHD deviated by <10% of prescription over the course of treatment when the PBS field was painted twice in each session. For one patient with target motion perpendicular to the beam (>5 mm), the degradation of ITV D 98% was 9%, which was effectively mitigated by employing large spots. One patient exhibited large dose degradation due to pericardial effusion, which required replanning across all modalities. Conclusions: This study demonstrates that PBS plans significantly reduce MLD and MHD relative to 3D-CRT, IMRT, and DS and identifies requirements for robust free-breathing ML PBS treatments, showing that PBS plan robustness can be maintained with repainting and/or large spots.

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Section: Treatment Planningmentioning

confidence: 99%

Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

et al. 2016

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“…Changes include replacement of MOPP by ABVD; elimination of radiation therapy (with more recent trials exploring omitting radiation therapy based on early positron emission tomography response 45 ); and reduction of radiation volume from the historical extended field that included a full mantle field encompassing the submandibular, cervical, supraclavicular, infraclavicular, axillary, mediastinal, subcarinal, and hilar lymph nodes matched to an abdominal and splenic field to involved-field and, most recently, to involved-node/involved-site radiotherapy. 46 Radiotherapy technique has evolved from rudimentary 2D planning to 3D planning with modern image guidance, techniques, and maneuvers to spare doses to lungs, heart, and breasts in a mediastinal field, including deep-inspiration breath hold techniques, inclined board, and intensity-modulated radiotherapy with "butterfly" technique. Radiobiological modeling studies have been conducted to estimate the reduction in risk of second malignancy and cardiovascular disease using involved-node radiotherapy and lower doses of radiation therapy, 47 showing a several-fold reduction in the risks with modern radiotherapy volume and doses.…”

Section: Modern Treatment and Implications On Late Effectsmentioning

confidence: 99%

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

2014

Hematology

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Long-term survivors of Hodgkin lymphoma (HL) are at an increased risk for a range of late complications, with subsequent malignant neoplasm and cardiovascular disease representing the 2 leading causes of death in these patients. Raising awareness, close follow-up, and adoption of selected early-detection and risk-reduction strategies may help to reduce the adverse impact of these late effects on patients. This chapter reviews known long-term complications of HL therapy, risk factors, and the timing of their occurrence. Where available, data on the efficacy of screening for selected late effects of HL are presented. Current evidence-based and consensus-based recommendations on follow-up of long-term HL survivors are also reviewed. As HL therapy evolves over time, late effects and implications on follow-up of patients treated in the contemporary era should be considered and opportunities for future research should be explored. Learning Objectives• To review the risk of and risk factors for late effects after HL therapy • To discuss data on the efficacy of screening strategies for selected late effects of HL • To summarize current follow-up recommendations for longterm HL survivors

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“…[1][2][3][4][5] For the early-stage Hodgkin lymphoma (HL) and Non-HL (NHL), the combined modality treatment (CMT) has shown higher patient survival and better local tumor control. 6,7 Staging is performed by physical examination, blood test, and tomographic imaging (usually computed tomography [CT] preferably coupled with [ 18 F]-fluorodeoxyglucose positron emission tomography [[ 18 F]FDG-PET]), which provides anatomical and metabolic information about the lymph nodes involved.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy of Hodgkin and Non-Hodgkin Lymphoma

Zaffino

Ciardo

Piperno

et al. 2015

Technol Cancer Res Treat

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Purpose: To improve the contouring of clinical target volume for the radiotherapy of neck Hodgkin/non-Hodgkin lymphoma by localizing the prechemotherapy gross target volume onto the simulation computed tomography using [18 F]-fluorodeoxyglucose positron emission tomography/computed tomography. Material and Methods: The gross target volume delineated on prechemotherapy [18 F]-fluorodeoxyglucose positron emission tomography/computed tomography images was warped onto simulation computed tomography using deformable image registration. Fifteen patients with neck Hodgkin/non-Hodgkin lymphoma were analyzed. Quality of image registration was measured by computing the Dice similarity coefficient on warped organs at risk. Five radiation oncologists visually scored the localization of automatic gross target volume, ranking it from 1 (wrong) to 5 (excellent). Deformable registration was compared to rigid registration by computing the overlap index between the automatic gross target volume and the planned clinical target volume and quantifying the V 95 coverage. Results: The Dice similarity coefficient was 0.80 + 0.07 (median + quartiles). The physicians' survey had a median score equal to 4 (good). By comparing the rigid versus deformable registration, the overlap index increased from a factor of about 4 and the V 95 (percentage of volume receiving the 95% of the prescribed dose) went from 0.84 + 0.38 to 0.99 + 0.10 (median + quartiles). Conclusion: This study demonstrates the impact of using deformable registration between prechemotherapy [ 18 F]-fluorodeoxyglucose positron emission tomography/computed tomography and simulation computed tomography, in order to automatically localize the gross target volume for radiotherapy treatment of patients with Hodgkin/non-Hodgkin lymphoma.

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Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG)

Cited by 475 publications

References 24 publications

Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Radiotherapy of Hodgkin and Non-Hodgkin Lymphoma

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