TY - JOUR
T1 - The conundrum of Hodgkin lymphoma nodes: to be or not to be included in the involved node radiation fields. The EORTC-GELA lymphoma group guidelines
AU - Girinsky, Theodore
AU - Specht, Lena
AU - Ghalibafian, Mithra
AU - Edeline, Veronique
AU - Bonniaud, Guillaume
AU - Van Der Maazen, Richard
AU - Aleman, Berthe
AU - Paumier, Amaury
AU - Meijnders, Paul
AU - Lievens, Yolande
AU - Noordijk, Evert
AU - Poortmans, Philip
AU - EORTC-GELA Lymphoma Group
AU - Girinsky, Theodore
AU - Specht, Lena
AU - Ghalibafian, Mithra
AU - Edeline, Veronique
AU - Bonniaud, Guillaume
AU - Van Der Maazen, Richard
AU - Aleman, Berthe
AU - Paumier, Amaury
AU - Meijnders, Paul
AU - Lievens, Yolande
AU - Noordijk, Evert
AU - Poortmans, Philip
AU - EORTC-GELA Lymphoma Group
N1 - Keywords: Contrast Media; Fluorodeoxyglucose F18; Hodgkin Disease; Humans; Lymphatic Irradiation; Lymphatic Metastasis; Practice Guidelines as Topic; Radiopharmaceuticals; Survival Analysis; Tomography, Emission-Computed; Tomography, X-Ray Computed; Treatment Outcome
PY - 2008/8/1
Y1 - 2008/8/1
N2 - PURPOSE: To develop easily applicable guidelines for the determination of initially involved lymph nodes to be included in the radiation fields. PATIENTS AND METHODS: Patients with supra-diaphragmatic Hodgkin lymphoma. All the imaging procedures were carried out with patients in the treatment position. The prechemotherapy PET/CT was coregistered with the postchemotherapy CT simulation for planning purposes. Initially involved lymph nodes were determined on fused prechemotherapy CT and FDG-PET imaging data. The initial assessment was verified with the postchemotherapy CT scan. RESULTS: The classic guidelines for determining the involvement of lymph nodes were not easily applicable and did not seem to reflect the exact extent of Hodgkin lymphoma. Three simple steps were used to pinpoint involved lymph nodes. First, FDG-PET scans were meticulously analysed to detect lymph nodes that were overlooked on CT imaging. Second, any morphological and/or functional asymmetry was sought on CT and FDG-PET scans. Third, a decrease in size or the disappearance of initially visible lymph nodes on the prechemotherapy CT scan as compared to the postchemotherapy CT scan was considered as surrogate proof of initial involvement. CONCLUSIONS: All the radiological procedures should be performed on patients in the treatment position for proper coregistration. It is highly advisable that all CT and/or CT/PET scans be performed with IV contrast. Using the above-mentioned three simple guidelines, initially involved lymph nodes can be detected with very satisfactory accuracy. It is also emphasized that the classic guidelines (2, 3, 4) can always be used when deemed necessary.
AB - PURPOSE: To develop easily applicable guidelines for the determination of initially involved lymph nodes to be included in the radiation fields. PATIENTS AND METHODS: Patients with supra-diaphragmatic Hodgkin lymphoma. All the imaging procedures were carried out with patients in the treatment position. The prechemotherapy PET/CT was coregistered with the postchemotherapy CT simulation for planning purposes. Initially involved lymph nodes were determined on fused prechemotherapy CT and FDG-PET imaging data. The initial assessment was verified with the postchemotherapy CT scan. RESULTS: The classic guidelines for determining the involvement of lymph nodes were not easily applicable and did not seem to reflect the exact extent of Hodgkin lymphoma. Three simple steps were used to pinpoint involved lymph nodes. First, FDG-PET scans were meticulously analysed to detect lymph nodes that were overlooked on CT imaging. Second, any morphological and/or functional asymmetry was sought on CT and FDG-PET scans. Third, a decrease in size or the disappearance of initially visible lymph nodes on the prechemotherapy CT scan as compared to the postchemotherapy CT scan was considered as surrogate proof of initial involvement. CONCLUSIONS: All the radiological procedures should be performed on patients in the treatment position for proper coregistration. It is highly advisable that all CT and/or CT/PET scans be performed with IV contrast. Using the above-mentioned three simple guidelines, initially involved lymph nodes can be detected with very satisfactory accuracy. It is also emphasized that the classic guidelines (2, 3, 4) can always be used when deemed necessary.
U2 - 10.1016/j.radonc.2008.05.012
DO - 10.1016/j.radonc.2008.05.012
M3 - Journal article
C2 - 18555548
SN - 0167-8140
VL - 88
SP - 202
EP - 210
JO - Radiotherapy & Oncology
JF - Radiotherapy & Oncology
IS - 2
ER -