Predictors of Hypothyroidism in Hodgkin Lymphoma Survivors After Intensity Modulated Versus 3-Dimensional Radiation Therapy

Pinnix, Chelsea C.; Cella, Laura; Andraos, T.Y.; Ayoub, Zeina; Milgrom, Sarah A.; Gunther, Jillian R.; Thosani, Sonali; Wogan, Christine F.; Conson, Manuel; D’Avino, Vittoria; Oki, Yasuhiro; Fanale, Michelle A.; Lee, Hun J.; Neelapu, Sattva S.; Fayad, Luis; Hagemeister, Frederick; Rodriguez, Maria Alma; Nastoupil, Loretta J.; Nieto, Yago; Qiao, Wei; Pacelli, Roberto; Dabaja, Bouthaina S.

doi:10.1016/j.ijrobp.2018.03.003

Cited by 25 publications

(35 citation statements)

References 23 publications

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“…For patients with lymphoma, much lower RT organ constraints are considered appropriate, as established by survivorship studies and/or dosimetric RT studies based on patient populations with lymphoma. [16][17][18][19][20]24 We compared the RT doses administered to the heart (Figure 1A), lung ( Figure 1B), breasts among the 18 female patients ( Figure 1C), thyroid gland ( Figure 1D), parotid glands ( Figure 1E), and submandibular glands ( Figure 1F) with the QUANTEC and lymphoma dose constraints. The mean heart mean dose was 0.8 Gy (range, 0-4.8 Gy) ( Figure 2); all patients were below both QUANTEC (26 Gy) and lymphoma (5 Gy) MHD constraints.…”

Section: Resultsmentioning

confidence: 99%

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

et al. 2020

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IMPORTANCE Response-adapted randomized trials have used positron emission tomographycomputed tomography to attempt to identify patients with early-stage favorable Hodgkin lymphoma (ESFHL) who could be treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiation therapy (RT). While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects; however, the application of modern RT could limit these toxic effects. OBJECTIVE To determine the radiation doses delivered to organs at risk with modern involved-site RT among patients with ESFHL treated with 20 Gy after 2 cycles of ABVD. DESIGN, SETTING, AND PARTICIPANTS This case series included 42 adult patients with ESFHL (according to the German Hodgkin Study Group criteria) who were treated between 2010 and 2019, achieved complete response by positron emission tomography-computed tomography (1-3 on 5-point scale) following 2 cycles of ABVD, and then received consolidative RT. The study was conducted at a single comprehensive cancer center. EXPOSURES 2 cycles of chemotherapy followed by 20-Gy involved-site RT. MAIN OUTCOMES AND MEASURES The medical records of patients with ESFHL were examined. Organs at risk were contoured, and doses were calculated. Progression-free survival, defined from date of diagnosis to disease progression, relapse, or death, and overall survival were estimated using the Kaplan-Meier method. RESULTS The cohort comprised 42 patients with ESFHL (median [range] age at diagnosis, 35 [18-74] years; 18 [43%] women; 24 [57%] with stage II disease). At a median follow-up of 44.6 (95% CI, 27.6-61.6) months, the 3-year progression-free survival and overall survival rates were 91.2% (95% CI, 74.9%-97.1%) and 97.0% (95% CI, 80.4%-99.6%), respectively. The mean heart dose was less than 5 Gy (mean, 0.8 Gy; SD, 1.5 Gy; range, 0-4.8 Gy) in all patients. The mean (SD) breast dose for both breasts was 0.1 (0.2) Gy (left breast range, 0-1.0 Gy; right breast range, 0-0.9 Gy). CONCLUSIONS AND RELEVANCE In this study, combined modality therapy with 2 cycles of ABVD and 20 Gy for ESFHL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.

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Section: Resultsmentioning

confidence: 99%

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

et al. 2020

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“…Receiver operating characteristics ROC analysis (14,15), already adopted by other authors to identify dosimetric parameters associated with RT damage (16,17), was used to identify the dosimetric parameters related to the risk of G2 alopecia. The maximum value of the Youden index (J) (18) was used for selecting the optimal cut-off point for each dosimetric variable.…”

Section: Methodsmentioning

confidence: 99%

“…Data regarding volumes in cc were collected both for the whole scalp and for the areas of acute alopecia. The following dosimetric parameters were collected: dose received by 0.1 cc of the ROI (D 0.1cc ), mean dose (D mean ), absolute volumes that received 16,20,25,30,35,40, and 43 Gy (V 16Gy , V 20Gy , V 25Gy , V 30Gy , V 35Gy , V 40Gy , and V 43Gy ).…”

Section: Hair Loss Assessmentmentioning

confidence: 99%

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

et al. 2020

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Purpose: To determine dose constraints that correlate with alopecia in patients treated with photon-based Volumetric Modulated Arc Therapy (VMAT) for primary brain tumors.Methods: During the treatment planning process, the scalp was drawn as a region of interest. Dose received by 0.1 cc (D 0.1cc ), mean dose (D mean ), absolute volumes receiving different doses (V 16Gy , V 20Gy , V 25Gy , V 30Gy , V 35Gy , V 40Gy , and V 43Gy ) were registered for the scalp. Alopecia was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Receiver operating characteristics (ROC) curve analysis was used to identify parameters associated with hair-loss.Results: One-hundred and one patients were included in this observational study. At the end of radiotherapy (RT), 5 patients did not develop alopecia (D mean scalp 3.1 Gy). The scalp of the patients with G1 (n = 11) and G2 (n = 85) alopecia received D mean of 10.6 Gy and 11.8 Gy, respectively. At ROC analysis, V 16Gy20Gy ≥ 5.2 cc were the strongest predictors of acute alopecia risk. Chronic hair-loss assessment was available for 74 patients: median time to recovery from G2 alopecia was 5, 9 months. The actuarial rate of hair regrowth was 98.1% at 18 months after the end of RT. At ROC analysis, V 40Gy43Gy ≥2.2 cc were the strongest predictors of chronic G2-alopecia risk. V 20Gy, V 40Gy , and D 0,1cc were shown to be independent variables according to correlation coefficient r.Conclusions: V 20Gy and V 40Gy were the strongest predictors for acute and chronic G2 hair-loss, respectively. The low-dose bath typical of VMAT corresponds to large areas of acute but transient alopecia. However, the steep dose gradient of VMAT allows to reduce the areas of the scalp that receive higher doses, minimizing the risk of permanent alopecia. Scoccianti et al. Predictors of Radiotherapy-Induced AlopeciaThe application of our dosimetric findings for the scalp may help in reducing the alopecia risk and also in estimating the probability of hair-loss during patient counseling before starting radiotherapy.

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“…The same study also identified a threshold value for V20: in patients with a V20 higher or lower than 82.4%, the risk of hypothyroidism was 60.7 and 13.6%, respectively. A more recent study [83] assessed the risk of hypothyroidism in patients treated with IMRT: for V25, the threshold value was 63.5% (37% vs. 80% hypothyroidism), while the cut-off for V30 was 62%. Another parameter found to be related to the risk of functional damage was the amount of thyroid tissue receiving less than 25Gy, with a threshold value at 2.2 ml.…”

Section: Thyroidmentioning

confidence: 99%

Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin’s lymphoma involving the mediastinum

et al. 2020

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Aim: Advances in therapy have resulted in improved cure rates and an increasing number of long-term Hodgkin's lymphoma (HL) survivors. However, radiotherapy (RT)-related late effects are still a significant issue, particularly for younger patients with mediastinal disease (secondary cancers, heart diseases). In many Centers, technological evolution has substantially changed RT planning and delivery. This consensus document aims to analyze the current knowledge of Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) for mediastinal HL and formulate practical recommendations based on scientific evidence and expert opinions. Methods: A dedicated working group was set up within the Fondazione Italiana Linfomi (FIL) Radiotherapy Committee in May 2018. After a first meeting, the group adopted a dedicated platform to share retrieved articles and other material. Two group coordinators redacted a first document draft, that was further discussed and finalized in two subsequent meetings. Topics of interest were: 1) Published data comparing 3D-conformal radiotherapy (3D-CRT) and IMRT 2) dose objectives for the organs at risk 3) IGRT protocols and motion management.

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Predictors of Hypothyroidism in Hodgkin Lymphoma Survivors After Intensity Modulated Versus 3-Dimensional Radiation Therapy

Abstract: The percentage of the thyroid receiving 25 Gy and the volume of the thyroid spared from 25 Gy predicted the risk of hypothyroidism after either IMRT or 3D-CRT for HL. IMRT may confer a higher risk than 3D-CRT unless a treatment avoidance structure is used during planning.

Cited by 25 publications

References 23 publications

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

Dosimetric Predictors of Acute and Chronic Alopecia in Primary Brain Cancer Patients Treated With Volumetric Modulated Arc Therapy

Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin’s lymphoma involving the mediastinum

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