PMID- 23910709
OWN - NLM
STAT- MEDLINE
DCOM- 20131030
LR  - 20220409
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 87
IP  - 2
DP  - 2013 Oct 1
TI  - Doses to carotid arteries after modern radiation therapy for Hodgkin lymphoma: is 
      stroke still a late effect of treatment?
PG  - 297-303
LID - S0360-3016(13)00653-6 [pii]
LID - 10.1016/j.ijrobp.2013.06.004 [doi]
AB  - PURPOSE: Hodgkin lymphoma (HL) survivors are at an increased risk of stroke 
      because of carotid artery irradiation. However, for early-stage HL involved node 
      radiation therapy (INRT) reduces the volume of normal tissue exposed to high 
      doses. Here, we evaluate 3-dimensional conformal radiation therapy (3D-CRT), 
      volumetric-modulated arc therapy (VMAT), and proton therapy (PT) delivered as 
      INRT along with the extensive mantle field (MF) by comparing doses to the carotid 
      arteries and corresponding risk estimates. METHODS AND MATERIALS: We included a 
      cohort of 46 supradiaphragmatic stage I-II classical HL patients. All patients 
      were initially treated with chemotherapy and INRT delivered as 3D-CRT (30 Gy). 
      For each patient, we simulated MF (36 Gy) and INRT plans using VMAT and PT (30 
      Gy). Linear dose-response curves for the 20-, 25-, and 30-year risk of stroke 
      were derived from published HL data. Risks of stroke with each technique were 
      calculated for all patients. Statistical analyses were performed with repeated 
      measures analysis of variance. RESULTS: The mean doses to the right and left 
      common carotid artery were significantly lower with modern treatment compared 
      with MF, with substantial patient variability. The estimated excess risk of 
      stroke after 20, 25, and 30 years was 0.6%, 0.86%, and 1.3% for 3D-CRT; 0.67%, 
      0.96%, and 1.47% for VMAT; 0.61%, 0.96%, and 1.33% for PT; and 1.3%, 1.72%, and 
      2.61% for MF. CONCLUSIONS: INRT reduces the dose delivered to the carotid 
      arteries and corresponding estimated risk of stroke for HL survivors. Even for 
      the subset of patients with lymphoma close to the carotid arteries, the estimated 
      risk is low.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Maraldo, Maja V
AU  - Maraldo MV
AD  - Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, 
      Copenhagen, Denmark. dra.maraldo@gmail.com
FAU - Brodin, Patrick
AU  - Brodin P
FAU - Aznar, Marianne C
AU  - Aznar MC
FAU - Vogelius, Ivan R
AU  - Vogelius IR
FAU - Munck af Rosenschold, Per
AU  - Munck af Rosenschold P
FAU - Petersen, Peter M
AU  - Petersen PM
FAU - Specht, Lena
AU  - Specht L
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20130801
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Analysis of Variance
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Carotid Arteries/*radiation effects
MH  - Dose-Response Relationship, Radiation
MH  - Female
MH  - Hodgkin Disease/drug therapy/pathology/*radiotherapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Organs at Risk/*radiation effects
MH  - Proton Therapy/adverse effects
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Conformal/*adverse effects/methods
MH  - Radiotherapy, Intensity-Modulated/adverse effects/methods
MH  - Risk Assessment
MH  - Stroke/*etiology
MH  - Survivors
MH  - Time Factors
MH  - Young Adult
EDAT- 2013/08/06 06:00
MHDA- 2013/10/31 06:00
CRDT- 2013/08/06 06:00
PHST- 2013/04/03 00:00 [received]
PHST- 2013/05/31 00:00 [revised]
PHST- 2013/06/04 00:00 [accepted]
PHST- 2013/08/06 06:00 [entrez]
PHST- 2013/08/06 06:00 [pubmed]
PHST- 2013/10/31 06:00 [medline]
AID - S0360-3016(13)00653-6 [pii]
AID - 10.1016/j.ijrobp.2013.06.004 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2013 Oct 1;87(2):297-303. doi: 
      10.1016/j.ijrobp.2013.06.004. Epub 2013 Aug 1.