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

Autor:	Campbell BA; Department of Radiation Oncology and Cancer Imaging. Electronic address: Belinda.Campbell@petermac.org., Hornby C; Department of Radiotherapy., Cunninghame J; Department of Radiotherapy., Burns M; Department of Radiotherapy., MacManus M; Department of Radiation Oncology and Cancer Imaging., Ryan G; Department of Radiation Oncology and Cancer Imaging., Lau E; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne; Department of Radiology, University of Melbourne, Parkville., Seymour JF; Department of Haematology, Peter MacCallum Cancer Centre, Melbourne; Department of Medicine, University of Melbourne, Parkville, Australia., Wirth A; Department of Radiation Oncology and Cancer Imaging.
Jazyk:	angličtina
Zdroj:	Annals of oncology : official journal of the European Society for Medical Oncology [Ann Oncol] 2012 May; Vol. 23 (5), pp. 1259-1266. Date of Electronic Publication: 2011 Oct 06.
DOI:	10.1093/annonc/mdr439
Abstrakt:	Background: Chemotherapy plus radiotherapy is the standard of care for patients with limited stage Hodgkin lymphoma (HL). Radiotherapy is evolving from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) to decrease radiotherapy-related morbidity. In the absence of long-term toxicity data, dose-volume metrics of organs at risk (OAR) provide a surrogate measure of toxicity risk. Patients and Methods: Ten female patients with stage I-IIA supradiaphragmatic HL were randomly selected. All patients had pre-chemotherapy computerised tomography (CT) and CT-positron emission tomography staging. Using CT planning, three radiotherapy plans were produced per patient: (i) IFRT, (ii) INRT using parallel-opposed beams and (iii) INRT using volumetric modulated arc therapy (VMAT). Radiotherapy dose was 30.6 Gy in 1.8 Gy fractions. OAR evaluated were lungs, breasts, thyroid, heart and coronary arteries. Results: Compared with IFRT, INRT significantly reduced mean doses to lungs (P < 0.01), breasts (P < 0.01), thyroid (P < 0.01) and heart (P < 0.01), on Wilcoxon testing. Compared with conventional INRT, VMAT improved dose conformality but increased low-dose radiation exposure to lungs and breasts. VMAT reduced the heart volume receiving 30 Gy (V30) by 85%. Conclusions: 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.
Databáze:	MEDLINE
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