PMID- 25840609
OWN - NLM
STAT- MEDLINE
DCOM- 20160414
LR  - 20150606
IS  - 1433-2981 (Electronic)
IS  - 0936-6555 (Linking)
VI  - 27
IP  - 7
DP  - 2015 Jul
TI  - Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A 
      Comparison of Organ at Risk Dosimetry and Second Malignancy Risks.
PG  - 401-10
LID - S0936-6555(15)00106-5 [pii]
LID - 10.1016/j.clon.2015.03.005 [doi]
AB  - AIMS: Recent radiotherapy guidelines for lymphoma have included involved site 
      radiotherapy (ISRT), involved node radiotherapy (INRT) and irradiation of 
      residual volume after full-course chemotherapy. In the absence of late toxicity 
      data, we aim to compare organ at risk (OAR) dose-metrics and calculated second 
      malignancy risks. MATERIALS AND METHODS: Fifteen consecutive patients who had 
      received mediastinal radiotherapy were included. Four radiotherapy plans were 
      generated for each patient using a parallel pair photon technique: (i) involved 
      field radiotherapy (IFRT), (ii) ISRT, (iii) INRT, (iv) residual post-chemotherapy 
      volume. The radiotherapy dose was 30 Gy in 15 fractions. The OARs evaluated were: 
      breasts, lungs, thyroid, heart, oesophagus. Relative and absolute second 
      malignancy rates were estimated using the concept of organ equivalent dose. 
      Significance was defined as P < 0.005. RESULTS: Compared with ISRT, IFRT 
      significantly increased doses to lung, thyroid, heart and oesophagus, whereas 
      INRT and residual volume techniques significantly reduced doses to all OARs. The 
      relative risks of second cancers were significantly higher with IFRT compared 
      with ISRT for lung, breast and thyroid; INRT and residual volume resulted in 
      significantly lower relative risks compared with ISRT for lung, breast and 
      thyroid. The median excess absolute risks of second cancers were consistently 
      lowest for the residual technique and highest for IFRT in terms of thyroid, lung 
      and breast cancers. The risk of oesophageal cancer was similar for all four 
      techniques. Overall, the absolute risk of second cancers was very similar for 
      ISRT and INRT. CONCLUSIONS: Decreasing treatment volumes from IFRT to ISRT, INRT 
      or residual volume reduces radiation exposure to OARs. Second malignancy 
      modelling suggests that this reduction in treatment volumes will lead to a 
      reduction in absolute excess second malignancy. Little difference was observed in 
      second malignancy risks between ISRT and INRT, supporting the use of ISRT in the 
      absence of a pre-chemotherapy positron emission tomography scan in the 
      radiotherapy treatment position.
CI  - Copyright (c) 2015 The Royal College of Radiologists. Published by Elsevier Ltd. 
      All rights reserved.
FAU - Murray, L
AU  - Murray L
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK; 
      University of Leeds, Leeds, UK.
FAU - Sethugavalar, B
AU  - Sethugavalar B
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK.
FAU - Robertshaw, H
AU  - Robertshaw H
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK.
FAU - Bayman, E
AU  - Bayman E
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK.
FAU - Thomas, E
AU  - Thomas E
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK.
FAU - Gilson, D
AU  - Gilson D
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK.
FAU - Prestwich, R J D
AU  - Prestwich RJ
AD  - Department of Clinical Oncology, St. James's Institute of Oncology, Leeds, UK. 
      Electronic address: Robin.Prestwich@leedsth.nhs.uk.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20150401
PL  - England
TA  - Clin Oncol (R Coll Radiol)
JT  - Clinical oncology (Royal College of Radiologists (Great Britain))
JID - 9002902
RN  - 0 (Antineoplastic Agents)
RN  - 11056-06-7 (Bleomycin)
RN  - 5V9KLZ54CY (Vinblastine)
RN  - 7GR28W0FJI (Dacarbazine)
RN  - 80168379AG (Doxorubicin)
RN  - ABVD protocol
SB  - IM
MH  - Adult
MH  - Antineoplastic Agents/therapeutic use
MH  - Antineoplastic Combined Chemotherapy Protocols/administration & dosage
MH  - Bleomycin/administration & dosage
MH  - Dacarbazine/administration & dosage
MH  - Doxorubicin/administration & dosage
MH  - Female
MH  - Humans
MH  - Lymphatic Irradiation/*methods
MH  - Lymphoma/drug therapy/*radiotherapy
MH  - Male
MH  - Mediastinal Neoplasms/drug therapy/*radiotherapy
MH  - Middle Aged
MH  - Neoplasm, Residual/*radiotherapy
MH  - *Neoplasms, Second Primary/etiology
MH  - Organs at Risk/*radiation effects
MH  - Radiotherapy/adverse effects/methods
MH  - Radiotherapy Dosage
MH  - Risk Assessment
MH  - Vinblastine/administration & dosage
MH  - Young Adult
OTO - NOTNLM
OT  - Involved node
OT  - involved site
OT  - lymphoma
OT  - radiotherapy
OT  - second malignancy
EDAT- 2015/04/05 06:00
MHDA- 2016/04/15 06:00
CRDT- 2015/04/05 06:00
PHST- 2014/11/11 00:00 [received]
PHST- 2015/02/04 00:00 [revised]
PHST- 2015/03/12 00:00 [accepted]
PHST- 2015/04/05 06:00 [entrez]
PHST- 2015/04/05 06:00 [pubmed]
PHST- 2016/04/15 06:00 [medline]
AID - S0936-6555(15)00106-5 [pii]
AID - 10.1016/j.clon.2015.03.005 [doi]
PST - ppublish
SO  - Clin Oncol (R Coll Radiol). 2015 Jul;27(7):401-10. doi: 
      10.1016/j.clon.2015.03.005. Epub 2015 Apr 1.