Abstract
Objectives: Three-Dimensional Conformal Radiotherapy (3DCRT) has been successfully used to treat Hodgkin’s Lymphoma (HL) but treatment delivery is often complex and requires large fields that may result in significant exposure of normal tissues to ionizing radiation. The present study was undertaken to compare the dosimetry of Involved Field (IF) 3DCRT to HT in female patients treated for HL. Materials/Methods: A total of 10 young female patients affected with early stage mediastinal HL and treated with IF radiotherapy after chemotherapy were selected from our database. For each patient, 3DCRT and HT plans were designed to deliver 30 Gy to the target volume and 36 Gy in case of residual masses. HT planning solutions were optimized by inverse planning with specific dose-volume constraints on OAR (breasts, lungs, heart). Dose- Volume Histograms (DVHs) were calculated and then compared, both for target and OAR by a statistical analysis (Wilcoxon’s Test). Results: Mean doses to the PTV were almost identical for all plans. Conformity index was better with HT and homogeneity index didn’t differ. Mean dose to the breasts were increased with HT compared to 33DCRT (right breast: 3.28 vs 2.19, p<0.05; left breast: 3.76 vs 2.81, p<0.05) whereas no difference in mean doses appeared for heart, coronary arteries, lungs, thyroid and normal tissue. Maximal doses were reduced with HT for breasts (right breast: 19.9 vs 28.87, p<0.05; left breast: 24.76 vs 30.29, p<0.05) and spinal cord (20.87 vs 33.88, p<0.05). Volume exposed to high doses was smaller with HT whereas volume exposed to low doses was smaller with 3DCRT. Pronounced benefits of HT in terms of heart sparing were observed for patients with lymph nodes anterior to the heart. Conclusions: Although high dose to organ at risk was reduced with HT, increasing low dose especially to the breasts must be taken into account for IF HT. HT may be considered for large PTV especially when the anterior mediastinum is involved.
Highlights
Conclusions: high dose to organ at risk was reduced with HT, increasing low dose especially to the breasts must be taken into account for IF HT
Hodgkin lymphoma belongs to the group of malignancies with a high curability rate, as the 5-year relative survival is close to 84% for all forms of Hodgkin lymphoma combined, as a result of treatment based on chemotherapy and radiotherapy [1]
No significant difference in terms of the mean dose to the right breast and the left breast was observed between 3DCRT and tomotherapy, but, as expected, the V4 was higher with tomotherapy than with 3DCRT
Summary
Hodgkin lymphoma belongs to the group of malignancies with a high curability rate, as the 5-year relative survival is close to 84% for all forms of Hodgkin lymphoma combined, as a result of treatment based on chemotherapy and radiotherapy [1]. Progress in the management of Hodgkin lymphoma is related to the development of combination chemotherapy regimens and progress in radiotherapy techniques. These treatments are accompanied by late adverse effects such as cardiac toxicity and a risk of second cancers such as lung cancer and breast cancer for women [2,3,4,5,6,7,8]. The toxicity of radiotherapy can be decreased in three ways: reduce the dose, reduce treatment volumes and use innovative radiotherapy techniques such as Intensity-Modulated Radiotherapy (IMRT) [8]. The respective roles of the various radiotherapy techniques in the treatment of Hodgkin’s lymphoma differ from one radiotherapy centre to another and no consensus has been reached on this subject
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