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Title: Radiation Therapy Planning for Early-Stage Hodgkin Lymphoma: Experience of the International Lymphoma Radiation Oncology Group

Purpose: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs). Methods: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013. Results: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dosemore » (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient. Conclusions: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.« less
Authors:
 [1] ;  [2] ;  [3] ;  [4] ;  [5] ;  [3] ; ;  [1] ;  [2] ;  [4] ; ;  [5] ;  [3] ;  [1]
  1. Departments of Clinical Oncology and Hematology, Rigshospitalet, University of Copenhagen (Denmark)
  2. Department of Radiation Oncology, MD Anderson Cancer Center, Texas (United States)
  3. Department of Oncology, University of Torino School of Medicine, Torino (Italy)
  4. Department of Oncology, Christie Hospital, Manchester (United Kingdom)
  5. Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada)
Publication Date:
OSTI Identifier:
22458705
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 92; Journal Issue: 1; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPARATIVE EVALUATIONS; COMPUTERIZED TOMOGRAPHY; CRITICAL ORGANS; DIAGNOSIS; LYMPHOMAS; NECK; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; RECOMMENDATIONS; VARIATIONS