Abstract
BackgroundThe benefits of proton therapy in the treatment of patients with Hodgkin lymphoma (HL) are controversially discussed. Therefore we compared intensitiy modulated proton therapy (IMPT) with intensity modulated radiotherapy (IMRT), in the form of volumetric modulated arc therapy (VMAT) in patients with Hodgkin lymphoma (HL), through a comparative treatment planning study.MethodsRadiation plans for 21 patients with Hodgkin Lymphoma (HL) were computed for IMPT and deep inspiration breath hold (DIBH) VMAT. Plans were optimized and computed assuming deep inspiration breath holding conditions. Dosimetric comparison on standard metrics from dose volume histograms was performed to appraise the relative merits of the two techniques, while proton plan robustness was assessed by re-computing the dose distribution of each plan by varying the Hounsfield Units to stopping power calibration by applying a ± 3 and 4% error.ResultsDIBH-VMAT and IMPT both provided excellent coverage, conformity and heterogeneity of the clinical target volume (CTV) and planning target volume (PTV). IMPT reduced mean doses to the breasts, lungs, heart and normal tissue by 38–83%. IMPT significantly reduced mean doses to the heart to < 5 Gy despite bulky mediastinal disease and decreased breast doses in female patients to < 1 Gy. Despite the simulated 3 and 4% miscalibration errors, no remarkable or measurable impact was observed on the organs at risk (OARs).ConclusionsThis is the first comparison between DIBH-VMAT and IMPT in HL treatment. We could demonstrate statistically significant decreases in all dose/volume metrics of the OARs. Regardless of the planning paradigm used, range uncertainties can substantially under dose the PTV, while perhaps not leading to clinically significant deterioration of CTV coverage. With the geometry applied no impact was observed for OARs, suggesting IMPT as a superior technique for potentially reducing future health risks for HL patients.
Highlights
The benefits of proton therapy in the treatment of patients with Hodgkin lymphoma (HL) are controversially discussed
The numerical analysis conducted on the dose-volume histograms (DVH) for the various parameters considered are summarized in Table 2 for the targets and in Table 3 for the Organs at risk (OAR)
More than 95% of the prescribed dose was computed for the 98% of clinical target volume (CTV) and more than 90% of the dose was estimated to more than 95% of the planning target volume (PTV)
Summary
The benefits of proton therapy in the treatment of patients with Hodgkin lymphoma (HL) are controversially discussed. We compared intensitiy modulated proton therapy (IMPT) with intensity modulated radiotherapy (IMRT), in the form of volumetric modulated arc therapy (VMAT) in patients with Hodgkin lymphoma (HL), through a comparative treatment planning study. Multi-agent chemotherapy followed by radiation is the standard treatment for patients with Hodgkin Lymphoma (HL). The International Lymphoma Radiation Oncology Group (ILROG) contributed to standardizing the target volume definition and recommendations for treatment of HL patients, defining the involved site concept as a variation of involved node radiotherapy [11, 12, 16]. Changing the target volume concepts from involved field radiation (IFRT) to involved node (INRT), Weber et al [17] showed significantly decreased excess relative risk for breast, lung and thyroid regardless of the radiation technique used. The optimal technique, beam quality and delivery of radiation treatment are the subject of numerous comparative dose-planning studies and are still a matter of debate
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