Dosimetric and Clinical Outcomes of Involved-Field Intensity-Modulated Radiotherapy After Chemotherapy for Early-Stage Hodgkin’s Lymphoma With Mediastinal Involvement

• Published in: International journal of radiation oncology, biology, physics Vol. 84; no. 1; pp. 210 - 216
• Main Authors: Lu, Ning-Ning, M.D, Li, Ye-Xiong, M.D, Wu, Run-Ye, M.D, Zhang, Xi-Mei, M.D, Wang, Wei-Hu, M.D, Jin, Jing, M.D, Song, Yong-Wen, M.D, Fang, Hui, M.D, Ren, Hua, M.D, Wang, Shu-Lian, M.D, Liu, Yue-Ping, M.D, Liu, Xin-Fan, M.D, Chen, Bo, M.D, Dai, Jian-Rong, Ph.D, Yu, Zi-Hao, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Applied radiobiology (equipment, dosimetry...); Biological and medical sciences; Biological effects of radiation; Bleomycin - administration & dosage; CHEMOTHERAPY; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Dacarbazine - administration & dosage; Disease-Free Survival; Doxorubicin - administration & dosage; Female; Fundamental and applied biological sciences. Psychology; Hematologic and hematopoietic diseases; Hematology, Oncology and Palliative Medicine; Hodgkin Disease - drug therapy; Hodgkin Disease - mortality; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Hodgkin's disease; Hodgkin’s lymphoma; Humans; Intensity-modulated radiotherapy; Involved-field radiotherapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung; Lung - radiation effects; LUNGS; Lymph Nodes - pathology; LYMPHOMAS; Male; Mediastinal Neoplasms - drug therapy; Mediastinal Neoplasms - mortality; Mediastinal Neoplasms - pathology; Mediastinal Neoplasms - radiotherapy; MEDIASTINUM; Medical sciences; Middle Aged; Neoplasm Staging; Nodes; Organs at Risk - radiation effects; PATIENTS; PLANNING; Prognosis; Radiation; RADIATION DOSES; Radiation Injuries - pathology; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Intensity-Modulated - adverse effects; Survival; Survival Rate; Tissues, organs and organisms biophysics; TOXICITY; Tumor Burden; Vinblastine - administration & dosage; Young Adult; Involved-field radiotherapy; Intensity-modulated radiotherapy; Hodgkin’s lymphoma; Prognosis; Mediastinum; Hodgkin disease; Early stage; Malignant hemopathy; Lymphoma; Chemotherapy; Intensity modulated radiotherapy; Treatment; Cancerology; Lymphoproliferative syndrome; Dosimetry; Cancer; Hodgkin's lymphoma
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.11.008

Purpose To evaluate the dosimetric and clinical outcomes of involved-field intensity-modulated radiotherapy (IF-IMRT) for patients with early-stage Hodgkin’s lymphoma (HL) with mediastinal involvement. Methods and Materials Fifty-two patients with early-stage HL that involved the mediastinum were reviewed. Eight patients had Stage I disease, and 44 patients had Stage II disease. Twenty-three patients (44%) presented with a bulky mediastinum, whereas 42 patients (81%) had involvement of both the mediastinum and either cervical or axillary nodes. All patients received combination chemotherapy followed by IF-IMRT. The prescribed radiation dose was 30–40 Gy. The dose–volume histograms of the target volume and critical normal structures were evaluated. Results The median mean dose to the primary involved regions (planning target volume, PTV1) and boost area (PTV2) was 37.5 Gy and 42.1 Gy, respectively. Only 0.4% and 1.3% of the PTV1 and 0.1% and 0.5% of the PTV2 received less than 90% and 95% of the prescribed dose, indicating excellent PTV coverage. The median mean lung dose and V20 to the lungs were 13.8 Gy and 25.9%, respectively. The 3-year overall survival, local control, and progression-free survival rates were 100%, 97.9%, and 96%, respectively. No Grade 4 or 5 acute or late toxicities were reported. Conclusions Despite the large target volume, IF-IMRT gave excellent dose coverage and a favorable prognosis, with mild toxicity in patients with early-stage mediastinal HL.