Optimized Volumetric Modulated Arc Therapy Versus 3D-CRT for Early Stage Mediastinal Hodgkin Lymphoma Without Axillary Involvement: A Comparison of Second Cancers and Heart Disease Risk

Volumetric-modulated arc therapy (VMAT) versus 3D-conformal radiation therapy in supra-diaphragmatic Hodgkin’s Lymphoma with mediastinal involvement: A dosimetric comparison

“…Our data are comparable to the dose estimate comparison for ten patients with supra-diaphragmatic HL, planned using (3D CRT and VMAT, INRT/ISRT) in five ILROG centers having vast experience in the treatment of lymphomas [11]. Also, the increase in V5 and low-dose normal tissues with VMAT in the current study was comparable to other reports from similar studies [12,13,[18][19][20].…”

“…The use of more complex techniques such as optimized VMAT or IMRT allows dose ''tailoring" and offers better sparing of the critical structures. The trade-off with VMAT is that a larger volume of normal tissues being exposed to low-dose RT [2,12,13]. This increased low dose RT volume raises a major concern for a potential increased risk of developing second malignant tumor (SMT), especially breast cancer (BC) and thyroid cancer in female survivors [14][15][16][17].…”

“…This increased low dose RT volume raises a major concern for a potential increased risk of developing second malignant tumor (SMT), especially breast cancer (BC) and thyroid cancer in female survivors [14][15][16][17]. In a recent study, optimized VMAT using non co-planar arcs reduced the heart disease risk, as compared to 3D-CRT, with comparable estimated risks of thyroid and breast cancer, but with an increase in lung cancer induction probability [13]. The odds ratio for BC increases linearly with RT dose and decreases with the use of smaller RT volumes [13]; hence the importance of reducing RT dose and volume in mediastinal irradiation, a finding which was proven in one important study, where exclusion of axillae from supradiaphragmatic RT fields was associated with a substantial reduction of Breast Cancer risk among females previously reported with mantle fields [15].…”

Second cancer risk assessments after involved-site radiotherapy for mediastinal Hodgkin lymphoma

“…All plans consisted of two isocentric anteroposterior (AP) and posteroanterior (PA) fields with gantry angles of 0° and 180° giving a total dose of 30 Gy to the PTV. This irradiation technique has been extensively used for three‐dimensional conformal radiotherapy (3D CRT) for mediastinal HL . The XiO software was employed for the three‐dimensional treatment planning procedure (CMS Inc., St Louis, MO, USA).…”

Zaštita Od Zračenja Pacijenata U Toku Radioterapijskog Tretmana Primjenom Modernih Tehnika Zračenja

“…Istraživanje Fillipi et al pokazalo je da radioterapija limfoma VMAT tehnikom u odnosu na 3DCRT na regiju toraksa s regijom vrata ili bez nje uz ozračivanje većeg volumena zdravog tkiva malim dozama (V5) ima komparabilan rizik od sekundarnih karcinoma dojke i štitnjače, ali povećanu vjerojatnost sekundarnog karcinoma pluća uz značajno smanjen rizik bolesti srca [51].…”