Changing role and decreasing size: Current trends in radiotherapy for hodgkin’s disease

Yahalom, Joachim

doi:10.1007/s11912-002-0036-9

Cited by 13 publications

(7 citation statements)

References 73 publications

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“…Thus, for women treated with ovarysparing chemotherapy regimens, estimates in Tables 2 and 3 that correspond to no alkylating agents might be more appropriate. In the past few years, radiotherapy techniques for HL have been refi ned to incorporate smaller fi elds ( 40 ) and to use lower doses (range = 20 -30 Gy) ( 41 ) . These modifi cations result in exposure of smaller breast volumes to lower radiation doses and are expected to result in reduced risks of breast cancer in the future ( 12 , 13 ) .…”

Section: Discussionmentioning

confidence: 99%

Cumulative Absolute Breast Cancer Risk for Young Women Treated for Hodgkin Lymphoma

Travis

Hill

Dores

et al. 2005

JNCI: Journal of the National Cancer Institute

380

221

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Breast cancer projections varied considerably by type of HL therapy, time since HL diagnosis, and age at end of follow-up. These estimates are applicable to HL survivors treated with regimens of the past and can be used to counsel such patients and plan management and preventive strategies. Projections should be used with caution, however, in patients treated with more recent approaches, including limited-field radiotherapy and/or ovary-sparing chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Cumulative Absolute Breast Cancer Risk for Young Women Treated for Hodgkin Lymphoma

Travis

Hill

Dores

et al. 2005

JNCI: Journal of the National Cancer Institute

380

221

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“…With the success of therapy for early‐stage Hodgkin’s lymphoma, minimizing the risk of the late effects of treatment has become an important consideration in optimizing initial therapy 10 . With increasing recognition of the role of radiotherapy in producing late effects, the role of radiotherapy in the treatment of Hodgkin’s lymphoma has changed dramatically and some clinicians have questioned the routine use of radiotherapy for Hodgkin’s lymphoma 3,7,11,12 …”

Section: Discussionmentioning

confidence: 99%

Phantom measurements and computed estimates of breast dose with radiotherapy for Hodgkin’s lymphoma: Dose reduction with the use of the involved field*

et al. 2008

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The risk of breast cancer following radiotherapy for Hodgkin's lymphoma appears to be dose related. In this study we compared breast dose in an anthropomorphic phantom for conventional 'mantle'; upper mediastinal/bilateral neck (minimantle) and unilateral neck fields, and evaluated the accuracy of computer planned dose estimates for out-of-field doses. For each field, computer-planned breast dose (CPD) estimates were compared with thermoluminescence dosimetry measurements in five locations within 'breast tissue'. CPD were also compared with ion chamber measurements in a slab phantom. Measured dose and CPD were within 20% of each other up to approximately 10 cm from the field edge. Beyond 10 cm, the CPD underestimated dose by a factor of 2 or more. The mini-mantle reduced the breast dose by a factor of approximately 10 compared with the mantle treatment. Treating the neck field lowered the breast dose by a further 50% or more. Modern involved-field radiotherapy for lymphoma substantially reduces breast dose compared with mantle fields. Computer dosimetery underestimated dose at larger distances from the field. This needs to be considered if computer dosimetery is used to estimate breast dose and, by extrapolation, breast cancer risk.

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“…6 Traditionally, early-stage LPHL and classic Hodgkin lymphoma have been treated with wide-field radiotherapy (RT) or, more recently, with limited chemotherapy and involved-field RT. 7 However, the indolent natural history of LPHL and concerns about late treatment-related toxicity have led to interest in minimizing initial treatment. 2,8 -10 Several investigators have advocated strategies used for early-stage, indolent non-Hodgkin lymphoma (NHL), including involved-field RT, or observation if all known disease has been excised.…”

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confidence: 99%

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

Wirth

Yuen

Bartoň

et al. 2005

Cancer

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BACKGROUNDThe curative potential of radiotherapy (RT) alone as initial treatment for patients with Stage I–II lymphocyte‐predominant Hodgkin lymphoma (LPHL) has not been defined well.METHODSTwo hundred two patients who were treated between 1969 and 1995 were evaluated in a retrospective, multicenter study.RESULTSPatient characteristics were as follows: The median age was 31 years, 75% of patients were male, 80% of patients had Ann Arbor Stage I disease, 1% of patients had bulky disease, 3% of patients had B symptoms, 1% of patients had extranodal involvement, and 80% of patients had supradiaphragmatic disease. The RT fields were a full mantle field in 52% of patients, less than a full mantle field in 24% of patients, an inverted‐Y field in 17% of patients, less than an inverted‐Y field in 3% of patients, and total lymph node irradiation in 3% of patients. The median dose was 36 Gray. The median follow‐up was 15 years. The overall survival (OS) rate at 15 years was 83%, and freedom from progression (FFP) was observed in 82% of patients, including 84% of patients with Stage I disease and 73% of patients with Stage II disease. No recurrent LPHL and only 1 patient with non‐Hodgkin lymphoma (NHL) were reported after 15 years. Adverse prognostic factors that were identified on multifactor analysis were as follows: for OS, age 45 years or older (P < 0.0005), the presence of B symptoms (P = 0.002), increasing number of sites (P = 0.015); for FFP, increasing number of sites (P = 0.002). No significant difference was found in FFP in a comparison of patients who received elective mediastinal RT with patients who did not receive mediastinal RT (P = 0.11). Causes of death at 15 years were LPHL in 3% of patients, NHL in 2% of patients, in‐field malignancy in 2% of patients, in‐field cardiac/respiratory in 4% of patients, and other in 6% of patients.CONCLUSIONSThe current data suggested that RT potentially may be curative for patients with Stage I–II LPHL and raise the possibility that limited‐field RT may be used without loss of treatment efficacy. Involved‐field RT warrants further investigation for patients with early‐stage LPHL. Cancer 2005. © 2005 American Cancer Society.

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Changing role and decreasing size: Current trends in radiotherapy for hodgkin’s disease

Cited by 13 publications

References 73 publications

Cumulative Absolute Breast Cancer Risk for Young Women Treated for Hodgkin Lymphoma

Cumulative Absolute Breast Cancer Risk for Young Women Treated for Hodgkin Lymphoma

Phantom measurements and computed estimates of breast dose with radiotherapy for Hodgkin’s lymphoma: Dose reduction with the use of the involved field*

Long‐term outcome after radiotherapy alone for lymphocyte‐predominant Hodgkin lymphoma

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