Abstract
Background: Multiple methods have been implemented to limit the impact of radiotherapy on patients affected by mediastinal lymphoma, including breathing control techniques, image-guided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT), although the actual diffusion of such techniques is unclear. No surveys have been published to date evaluating the techniques adopted at different centers. Methods: A survey with a dedicated questionnaire was submitted to 195 Italian radiotherapy centers, assessing items regarding the characteristics of the center and clinical practice in the treatment of mediastinal lymphomas. Results: A total of 43 centers (22%) responded, the majority of which were university hospitals (37.2%) or cancer care centers (27.9%). In 95.4% of the centers, IMRT was used in the clinical practice, and the most frequently employed techniques were VMAT (48.8% of centers) and non-rotational IMRT (31.7%). Comparison of multiple plans was performed by 66.7% of the responding centers. Dose constraints for organs at risk were consistently prescribed. IGRT techniques were adopted by 93% of the centers, while breathing control or gating techniques were routinely used by only 25.6% of the centers. A necessity to standardize OAR constraints and define guidelines was perceived by almost all participants. Conclusions: Modern radiotherapy techniques are widely used in the Italian centers, although with heterogeneous characteristics.
Highlights
Radiation therapy still has a primary role in combination with chemotherapy for treating early-stage lymphomas based on a risk and response-adapted strategy [1,2]
Characteristics of the center; Total number of patients treated with external beam radiotherapy (EBRT) and number of patients with mediastinal lymphoma treated in 2017; Adoption of intensity-modulated radiotherapy (IMRT) in clinical practice for the treatment of mediastinal lymphomas, image fusion with diagnostic imaging, frequency of the use of the IMRT technique and comparison of ‘rival’ plans during treatment planning procedures; Use of specific dose constraints for the OARs; presence of differences with constraints used for solid tumors; contouring of cardiac sub-structures; Adoption of breathing control and/or gating techniques; Use and frequency of imageguided radiotherapy (IGRT); Perceived necessity of standardization of techniques and dose constraints
The mean and median estimated numbers of patients treated for mediastinal lymphoma in 2017 at each center were, respectively, 16.1 and 10
Summary
Radiation therapy still has a primary role in combination with chemotherapy for treating early-stage lymphomas based on a risk and response-adapted strategy [1,2]. The systematic adoption of PET-CT for the staging and evaluation of disease response and prognosis [7,8] allowed the reduction in prescription doses and treatment fields from extended field (EFRT) to the current standard of involved site RT (ISRT) or involved node. The implementation of modern planning techniques led to the development of different intensity-modulated radiation therapy (IMRT) solutions, improving dose conformality. Multiple methods have been implemented to limit the impact of radiotherapy on patients affected by mediastinal lymphoma, including breathing control techniques, imageguided radiotherapy (IGRT) and intensity-modulated radiotherapy (IMRT), the actual diffusion of such techniques is unclear. Methods: A survey with a dedicated questionnaire was submitted to 195 Italian radiotherapy centers, assessing items regarding the characteristics of the center and clinical practice in the treatment of mediastinal lymphomas. A necessity to standardize OAR constraints and define guidelines was perceived by almost all participants
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