Comparing Breath Hold and Free Breathing during Intensity-Modulated Radiation Therapy and Proton Therapy in Patients with Mediastinal Hodgkin Lymphoma

Hoppe, B.S.; Mendenhall, Nancy P.; Louis, Debbie; Li, Zuofeng; Flampouri, Stella

doi:10.14338/ijpt-17-00012

Cited by 16 publications

(8 citation statements)

References 10 publications

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“…Thus, use of DIBH is ideal to reduce the motion of the mediastinum and its respiration-dependent change in shape (thinner during inspiration, wider during free breathing) ( Figure 7). 59 It is accomplished by acquisition of the anatomical data in a fixed respiratory phase. DIBH can have the additional benefit of displacing the heart inferiorly, as well as expanding the lungs away from the target, potentially reducing the dose received by these OARs.…”

Section: Motion Managementmentioning

confidence: 99%

Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines

Dabaja

Hoppe

Plastaras

et al. 2018

Blood

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Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.

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Section: Motion Managementmentioning

confidence: 99%

Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines

Dabaja

Hoppe

Plastaras

et al. 2018

Blood

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“…Four-dimensional computed tomography scan for target and OAR delineation and dose calculation is commonly used for proton lymphoma RT. Breath-hold techniques for motion management and lung dose reduction during therapy are less common and not well-described in the literature (69).…”

Section: Review Of Dosimetric Studies and Specific Oarsmentioning

confidence: 99%

“…In patients with disease limited to the superior mediastinum (above the carina), DIBH with photons may be associated with similar doses to the heart compared with free-breathing proton therapy, especially with lower prescription doses (such as 20 Gy [RBE]); however, DIBH with IMRT would still lead to a much higher integral body dose than free-breathing proton therapy. Furthermore, when mediastinal disease extends below the carina (eg, cardiophrenic lymph nodes), DIBH may not provide as great of a dose reduction to the heart given that the target volume must extend inferiorly to the heart (69). In a small dosimetric study (nZ7) comparing IMRT, intensity modulated proton therapy, and DIBH presented only in abstract form, the differences between intensity modulated proton therapy with free breathing and IMRT with DIBH were not statistically significant, aside from lower mean dose to the breast favoring protons (75).…”

Section: Impact Of Breath-hold Techniquementioning

confidence: 99%

“…On the other hand, centers that have been treating patients with proton therapy have observed that, in patients with lower mediastinal disease that drapes in front of the heart and/or involves cardiophrenic nodes, freebreathing proton therapy remains superior to DIBH with IMRT for the heart and integral dose ( Fig. E1; available online at www.redjournal.org) (69).…”

Section: Impact Of Breath-hold Techniquementioning

confidence: 99%

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Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

Tseng

Cutter

Plastaras

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…Both came to the conclusion that a further reduction of the burden on risk organs can be achieved through the use of IMPT. Furthermore, the expected reduction in life years can be assumed according to a mathematical model [ 29 , 30 ]. Our aim was to perform a dose comparative study, using intensity modulated proton (IMPT) and volumetric modulated arc therapy (VMAT) with photons with regard to target volumes and OARs.…”

Section: Introductionmentioning

confidence: 99%

Proton versus photon deep inspiration breath hold technique in patients with hodgkin lymphoma and mediastinal radiation

et al. 2018

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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.

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Comparing Breath Hold and Free Breathing during Intensity-Modulated Radiation Therapy and Proton Therapy in Patients with Mediastinal Hodgkin Lymphoma

Cited by 16 publications

References 10 publications

Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines

Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines

Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

Proton versus photon deep inspiration breath hold technique in patients with hodgkin lymphoma and mediastinal radiation

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