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

Theodore Girinsky; Lena Specht; Mithra Ghalibafian; Veronique Edeline; Guillaume Bonniaud; Richard Van Der Maazen; Berthe Aleman; Amaury Paumier; Paul Meijnders; Yolande Lievens; Evert Noordijk; Philip Poortmans; EORTC-GELA Lymphoma Group; Theodore Girinsky; Lena Specht; Mithra Ghalibafian; Veronique Edeline; Guillaume Bonniaud; Richard Van Der Maazen; Berthe Aleman; Amaury Paumier; Paul Meijnders; Yolande Lievens; Evert Noordijk; Philip Poortmans; EORTC-GELA Lymphoma Group

doi:10.1016/j.radonc.2008.05.012

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

Theodore Girinsky, Lena Specht, Mithra Ghalibafian, Veronique Edeline, Guillaume Bonniaud, Richard Van Der Maazen, Berthe Aleman, Amaury Paumier, Paul Meijnders, Yolande Lievens, Evert Noordijk, Philip Poortmans, EORTC-GELA Lymphoma Group, Theodore Girinsky, Lena Specht, Mithra Ghalibafian, Veronique Edeline, Guillaume Bonniaud, Richard Van Der Maazen, Berthe AlemanAmaury Paumier, Paul Meijnders, Yolande Lievens, Evert Noordijk, Philip Poortmans, EORTC-GELA Lymphoma Group

87 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Radiotherapy & Oncology
Volume	88
Issue number	2
Pages (from-to)	202-10
Number of pages	9
ISSN	0167-8140
DOIs	https://doi.org/10.1016/j.radonc.2008.05.012 https://doi.org/10.1016/j.radonc.2008.05.012
Publication status	Published - 1 Aug 2008

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Girinsky, T., Specht, L., Ghalibafian, M., Edeline, V., Bonniaud, G., Van Der Maazen, R., Aleman, B., Paumier, A., Meijnders, P., Lievens, Y., Noordijk, E., Poortmans, P., EORTC-GELA Lymphoma Group, Girinsky, T., Specht, L., Ghalibafian, M., Edeline, V., Bonniaud, G., Van Der Maazen, R., ... EORTC-GELA Lymphoma Group (2008). 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. Radiotherapy & Oncology, 88(2), 202-10. https://doi.org/10.1016/j.radonc.2008.05.012, https://doi.org/10.1016/j.radonc.2008.05.012

Girinsky, T, Specht, L, Ghalibafian, M, Edeline, V, Bonniaud, G, Van Der Maazen, R, Aleman, B, Paumier, A, Meijnders, P, Lievens, Y, Noordijk, E, Poortmans, P, EORTC-GELA Lymphoma Group, Girinsky, T, Specht, L, Ghalibafian, M, Edeline, V, Bonniaud, G, Van Der Maazen, R, Aleman, B, Paumier, A, Meijnders, P, Lievens, Y, Noordijk, E, Poortmans, P & EORTC-GELA Lymphoma Group 2008, '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', Radiotherapy & Oncology, vol. 88, no. 2, pp. 202-10. https://doi.org/10.1016/j.radonc.2008.05.012, https://doi.org/10.1016/j.radonc.2008.05.012

@article{d14bfa304c7b11df928f000ea68e967b,

title = "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",

abstract = "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.",

author = "Theodore Girinsky and Lena Specht and Mithra Ghalibafian and Veronique Edeline and Guillaume Bonniaud and {Van Der Maazen}, Richard and Berthe Aleman and Amaury Paumier and Paul Meijnders and Yolande Lievens and Evert Noordijk and Philip Poortmans and {EORTC-GELA Lymphoma Group} and Theodore Girinsky and Lena Specht and Mithra Ghalibafian and Veronique Edeline and Guillaume Bonniaud and {Van Der Maazen}, Richard and Berthe Aleman and Amaury Paumier and Paul Meijnders and Yolande Lievens and Evert Noordijk and Philip Poortmans and Lena Specht",

note = "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",

year = "2008",

month = aug,

day = "1",

doi = "10.1016/j.radonc.2008.05.012",

language = "English",

volume = "88",

pages = "202--10",

journal = "Radiotherapy & Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

number = "2",

}

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 -

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

Abstract

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