Radiation Therapy Planning for Early-Stage Hodgkin Lymphoma: Experience of the International Lymphoma Radiation Oncology Group

• Published in: International journal of radiation oncology, biology, physics Vol. 92; no. 1; pp. 144 - 152
• Main Authors: Maraldo, Maja V., MD, PhD, Dabaja, Bouthaina S., MD, Filippi, Andrea R., MD, Illidge, Tim, MD, PhD, Tsang, Richard, MD, Ricardi, Umberto, MD, Petersen, Peter M., MD, PhD, Schut, Deborah A., MRT(T), Garcia, John, CMD, Headley, Jayne, CMD, Parent, Amy, CMD, Guibord, Benoit, CMD, Ragona, Riccardo, MSc, Specht, Lena, MD, DMSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2015
• Subjects: Adult; Aged; Axilla; Breast - radiation effects; Cancer Care Facilities - standards; COMPARATIVE EVALUATIONS; COMPUTERIZED TOMOGRAPHY; CRITICAL ORGANS; DIAGNOSIS; Female; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Heart - diagnostic imaging; Heart - radiation effects; Hematology, Oncology and Palliative Medicine; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Hodgkin Disease - radiotherapy; Humans; Lung - diagnostic imaging; Lung - radiation effects; LYMPHOMAS; Male; Mediastinal Neoplasms - drug therapy; Mediastinal Neoplasms - pathology; Mediastinal Neoplasms - radiotherapy; Middle Aged; NECK; Organs at Risk - diagnostic imaging; Organs at Risk - radiation effects; PATIENTS; PLANNING; RADIATION DOSES; Radiation Oncology - standards; Radiography; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - methods; RECOMMENDATIONS; Thyroid Gland - diagnostic imaging; Thyroid Gland - radiation effects; VARIATIONS; Young Adult
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2014.12.009

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.