Radiation therapy planning for early-stage Hodgkin lymphoma: experience of the International Lymphoma Radiation Oncology Group

TY - JOUR

T1 - Radiation therapy planning for early-stage Hodgkin lymphoma

T2 - experience of the International Lymphoma Radiation Oncology Group

AU - Maraldo, Maja V

AU - Dabaja, Bouthaina S

AU - Filippi, Andrea R

AU - Illidge, Tim

AU - Tsang, Richard

AU - Ricardi, Umberto

AU - Petersen, Peter M

AU - Schut, Deborah A

AU - Garcia, John

AU - Headley, Jayne

AU - Parent, Amy

AU - Guibord, Benoit

AU - Ragona, Riccardo

AU - Specht, Lena

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - PURPOSE: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs).METHODS: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013.RESULTS: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient.CONCLUSIONS: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.

AB - PURPOSE: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs).METHODS: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013.RESULTS: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient.CONCLUSIONS: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.

KW - Adult

KW - Aged

KW - Axilla

KW - Breast

KW - Cancer Care Facilities

KW - Female

KW - Head and Neck Neoplasms

KW - Heart

KW - Hodgkin Disease

KW - Humans

KW - Lung

KW - Male

KW - Mediastinal Neoplasms

KW - Middle Aged

KW - Organs at Risk

KW - Radiation Oncology

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted

KW - Radiotherapy, Conformal

KW - Radiotherapy, Intensity-Modulated

KW - Thyroid Gland

KW - Young Adult

U2 - 10.1016/j.ijrobp.2014.12.009

DO - 10.1016/j.ijrobp.2014.12.009

M3 - Journal article

C2 - 25670544

SN - 0360-3016

VL - 92

SP - 144

EP - 152

JO - International Journal of Radiation Oncology, Biology, Physics

JF - International Journal of Radiation Oncology, Biology, Physics

IS - 1

ER -