PMID- 21980193
OWN - NLM
STAT- MEDLINE
DCOM- 20120907
LR  - 20240229
IS  - 1569-8041 (Electronic)
IS  - 0923-7534 (Linking)
VI  - 23
IP  - 5
DP  - 2012 May
TI  - Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a 
      dosimetric study of the benefit of involved node radiotherapy.
PG  - 1259-1266
LID - S0923-7534(19)34699-X [pii]
LID - 10.1093/annonc/mdr439 [doi]
AB  - BACKGROUND: Chemotherapy plus radiotherapy is the standard of care for patients 
      with limited stage Hodgkin lymphoma (HL). Radiotherapy is evolving from involved 
      field radiotherapy (IFRT) to involved node radiotherapy (INRT) to decrease 
      radiotherapy-related morbidity. In the absence of long-term toxicity data, 
      dose-volume metrics of organs at risk (OAR) provide a surrogate measure of 
      toxicity risk. PATIENTS AND METHODS: Ten female patients with stage I-IIA 
      supradiaphragmatic HL were randomly selected. All patients had pre-chemotherapy 
      computerised tomography (CT) and CT-positron emission tomography staging. Using 
      CT planning, three radiotherapy plans were produced per patient: (i) IFRT, (ii) 
      INRT using parallel-opposed beams and (iii) INRT using volumetric modulated arc 
      therapy (VMAT). Radiotherapy dose was 30.6 Gy in 1.8 Gy fractions. OAR evaluated 
      were lungs, breasts, thyroid, heart and coronary arteries. RESULTS: Compared with 
      IFRT, INRT significantly reduced mean doses to lungs (P < 0.01), breasts (P < 
      0.01), thyroid (P < 0.01) and heart (P < 0.01), on Wilcoxon testing. Compared 
      with conventional INRT, VMAT improved dose conformality but increased low-dose 
      radiation exposure to lungs and breasts. VMAT reduced the heart volume receiving 
      30 Gy (V30) by 85%. CONCLUSIONS: Reduction from IFRT to INRT decreased the 
      volumes of lungs, breasts and thyroid receiving high-dose radiation, suggesting 
      the potential to reduce long-term second malignancy risks. VMAT may be useful for 
      patients with pre-existing heart disease by minimising further cardiac toxicity 
      risks.
FAU - Campbell, B A
AU  - Campbell BA
AD  - Department of Radiation Oncology and Cancer Imaging. Electronic address: 
      Belinda.Campbell@petermac.org.
FAU - Hornby, C
AU  - Hornby C
AD  - Department of Radiotherapy.
FAU - Cunninghame, J
AU  - Cunninghame J
AD  - Department of Radiotherapy.
FAU - Burns, M
AU  - Burns M
AD  - Department of Radiotherapy.
FAU - MacManus, M
AU  - MacManus M
AD  - Department of Radiation Oncology and Cancer Imaging.
FAU - Ryan, G
AU  - Ryan G
AD  - Department of Radiation Oncology and Cancer Imaging.
FAU - Lau, E
AU  - Lau E
AD  - Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne; Department 
      of Radiology, University of Melbourne, Parkville.
FAU - Seymour, J F
AU  - Seymour JF
AD  - Department of Haematology, Peter MacCallum Cancer Centre, Melbourne; Department 
      of Medicine, University of Melbourne, Parkville, Australia.
FAU - Wirth, A
AU  - Wirth A
AD  - Department of Radiation Oncology and Cancer Imaging.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20111006
PL  - England
TA  - Ann Oncol
JT  - Annals of oncology : official journal of the European Society for Medical 
      Oncology
JID - 9007735
SB  - IM
MH  - Adult
MH  - Diaphragm/pathology/radiation effects
MH  - Female
MH  - Hodgkin Disease/pathology/*radiotherapy
MH  - Humans
MH  - Lymph Nodes/radiation effects
MH  - Lymphatic Irradiation/*adverse effects/methods
MH  - Lymphatic Metastasis/radiotherapy
MH  - Middle Aged
MH  - Organ Sparing Treatments/*methods
MH  - Organs at Risk/*radiation effects
MH  - Radiation Injuries/*prevention & control
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/adverse effects/*methods
MH  - Risk Assessment
MH  - Young Adult
EDAT- 2011/10/08 06:00
MHDA- 2012/09/08 06:00
CRDT- 2011/10/08 06:00
PHST- 2011/10/08 06:00 [entrez]
PHST- 2011/10/08 06:00 [pubmed]
PHST- 2012/09/08 06:00 [medline]
AID - S0923-7534(19)34699-X [pii]
AID - 10.1093/annonc/mdr439 [doi]
PST - ppublish
SO  - Ann Oncol. 2012 May;23(5):1259-1266. doi: 10.1093/annonc/mdr439. Epub 2011 Oct 6.