Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy

Campbell, Belinda A.; Hornby, Colin; Cunninghame, J.; Burns, Mark W.; MacManus, Michael; Ryan, Graeme B.; Lau, Eddie; Seymour, John F.; Wirth, Andrew

doi:10.1093/annonc/mdr439

Cited by 51 publications

(26 citation statements)

References 25 publications

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“…With regard to cardiac doses, dose or volume dependence for late toxicity remains unclear [29]. Other studies [18,24] have also included the proximal coronary arteries as a possible region that may relate to late complications; we were not able to reliably contour this region with our scan data/phase of contrast/experience. Campbell et al [18] found that although INRT offered a reduction in whole heart doses, the dose to proximal coronary arteries was not reduced.…”

Section: Discussionmentioning

confidence: 97%

“…Other studies [18,24] have also included the proximal coronary arteries as a possible region that may relate to late complications; we were not able to reliably contour this region with our scan data/phase of contrast/experience. Campbell et al [18] found that although INRT offered a reduction in whole heart doses, the dose to proximal coronary arteries was not reduced. Data from Paumier et al [24] suggests that additional techniques, such as deep inspiratory breath hold, are required to reduce the dose to the proximal coronary arteries.…”

Section: Discussionmentioning

confidence: 98%

“…For the purposes of this study all radiotherapy was planned with a parallel-opposed pair technique. There may be potential to use techniques including three-dimensional conformal and intensity-modulated radiotherapy (IMRT) techniques [18,20] for selected patients; the dosimetric and second malignancy calculations are technique dependent. Studies have consistently shown that IMRT techniques can reduce mean doses to OARs [20,30,31].…”

Section: Discussionmentioning

confidence: 99%

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Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks

et al. 2015

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks

et al. 2015

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“…Modern therapies, such as involved field radiotherapy, may reduce the long-term secondary malignancy risk from radiation treatments and protect the heart and coronary arteries by reducing mean radiation dose to the heart. 29 By limiting normal tissue exposure, these methods may be more important than total dose in terms of risk of long-term toxicities. 30 As late-effects mortality data on survivors treated more recently will not be available for many years, our model provides important insight by leveraging the best available clinical data now, and suggests that if involved field radiation reduces CRT excess cardiac risk by 50% or eliminates CRT excess second cancer risk all together, CT would still be associated with more favorable OS.…”

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confidence: 99%

Pediatric Hodgkin lymphoma: trade-offs between short- and long-term mortality risks

Yeh¹,

Diller

2012

Blood

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As pediatric Hodgkin lymphoma (HL) survival rates approach > 95%, treatment decisions are increasingly based on minimizing late effects. Using a model-based approach, we explored whether the addition of radiotherapy contributes to improved overall long-term survival. We developed a state-transition model to simulate the lifetime HL clinical course, and we compared 2 treatment strategies: chemotherapy alone (CT) and chemoradiotherapy (CRT). Data on HL relapse, late recurrence, and excess second cancer and cardiac late-effects mortality were estimated from the published literature and databases. Outcomes included conditional life expectancy, cause-specific mortality, and proportion alive at age 50. For a hypothetical cohort of HL patients (diagnosis age 15), conditional life expectancy was 57.2 years with CT compared with 56.4 years with CRT. Estimated lifetime HL mortality risk was 3.6% with CT versus 2.2% with CRT. In contrast, combined risk of excess late-effects mortality was lower for CT (1.8% vs 7.4% with CRT). Among those alive at age 50, only 9.2% of those initially treated with CT were at risk for radiation-related late effects (100% for CRT). Initial treatment with CT may be associated with longer average perperson life expectancy. These results support the need for careful consideration of the risk-benefit profile of radiation as frontline therapy in pediatric patients. (Blood. 2012;120(11):2195-2202)

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“…21 Dosimetric studies demonstrate that reducing the radiotherapy field from IFRT to INRT significantly reduces the radiation dose to lungs, breast, and thyroid. 29,30 Using dosimetric parameters as surrogate endpoints for toxicity, it is reasonable to extrapolate that these dose reductions are likely to translate into lower risks of radiation-induced toxicities and second malignancies in long-term survivors. Our group has retrospectively evaluated the impact of reduced radiotherapy field sizes on patterns of relapse and survival in limited-stage Hodgkin lymphoma and follicular lymphoma.…”

Section: -3mentioning

confidence: 99%

Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy

Campbell

Connors

Gascoyne

et al. 2012

Cancer

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BACKGROUND: For limited-stage diffuse large B-cell lymphoma (DLBCL), treatment decisions are often influenced by toxicity profiles. One strategy that minimizes chemotherapy-induced toxicities is abbreviated chemotherapy plus consolidation involved-field radiotherapy (IFRT). Involved-node radiotherapy (INRT) is a new concept to DLBCL, aimed to reduce radiotherapy-induced toxicities. We retrospectively review the long-term outcomes of limited-stage DLBCL treated with abbreviated systemic therapy and radiotherapy focusing on field size: IFRT versus INRT. METHODS: The British Columbia Cancer Agency Lymphoid Cancer Database was used to identify patients diagnosed with limited-stage DLBCL (stage I/II, without B-symptoms; bulk < 10 cm) from 1981 to 2007. Patients were prescribed 3 cycles of chemotherapy plus IFRT (1981-1996) or INRT5 cm (1996, defined as INRT to the prechemotherapy involved nodes with margins 5 cm. RESULTS: A total of 288 patients were identified: 56% were aged >60 years, 34% had stage II disease, 55% had extranodal disease, 19% had elevated lactate dehydrogenase levels, and 15% received rituximab. The two radiotherapy groups were IFRT (138 patients; 48%) and INRT5cm (150 patients; 52%); median follow-up was 117 and 89 months, respectively. Distant relapse was the most common site of failure in both groups. After INRT5 cm, marginal recurrence was infrequent (2%). Time to progression (P ¼ .823), progression-free survival (P ¼ .575), and overall survival (P ¼ .417) were not significantly different between the radiotherapy cohorts. Radiotherapy field size was not a significant prognostic factor on multivariate analyses. CONCLUSIONS: This research is the first known body of work to apply the concept of INRT to limited-stage DLBCL. Reducing the field size from IFRT to INRT5 cm maintains a low marginal recurrence risk with no impact on overall outcome. Cancer 2012;118:4156-65.

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Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy

Abstract: Reduction from IFRT to INRT decreased the volumes of lungs, breasts and thyroid receiving high-dose radiation, suggesting the potential to reduce long-term second malignancy risks. VMAT may be useful for patients with pre-existing heart disease by minimising further cardiac toxicity risks.

Cited by 51 publications

References 25 publications

Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks

Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks

Pediatric Hodgkin lymphoma: trade-offs between short- and long-term mortality risks

Limited‐stage diffuse large B‐cell lymphoma treated with abbreviated systemic therapy and consolidation radiotherapy

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