Prospective phase II trial of image-guided radiotherapy in Hodgkin lymphoma: Benefit of deep inspiration breath-hold

Authors

  • Peter M. Petersen Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark; Department of Haematology, Rigshospitalet, University of Copenhagen, Denmark
  • Marianne C. Aznar Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark; Niels Bohr Institute, Faculty of Sciences, University of Copenhagen, Denmark
  • Anne K. Berthelsen Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
  • Annika Loft Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
  • Deborah A. Schut Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark
  • Maja Maraldo Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark
  • Mirjana Josipovic Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark
  • Thomas L. Klausen Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
  • Flemming L. Andersen Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
  • Lena Specht Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen, Denmark; Department of Haematology, Rigshospitalet, University of Copenhagen, Denmark

DOI:

https://doi.org/10.3109/0284186X.2014.932435

Abstract

Background. Long-term Hodgkin lymphoma (HL) survivors have an increased risk of late cardiac morbidity and secondary lung cancer after chemotherapy and mediastinal radiotherapy. In this prospective study we investigate whether radiotherapy with deep inspiration breath-hold (DIBH) can reduce radiation doses to the lungs, heart, and cardiac structures without compromising the target dose.

Patients and methods. Twenty-two patients (14 female, 8 male), median age 30 years (18–65 years), with supra-diaphragmatic HL were enrolled and had a thoracic PET/CT with DIBH in addition to staging FDG-PET/CT in free breathing (FB) and a planning CT in both FB and DIBH. For each patient an involved-node radiotherapy plan was done for both DIBH and FB, and the doses to the lungs, heart, and female breasts were recorded prospectively. Mean doses to the heart valves and coronary arteries were recorded retrospectively. Patients were treated with the technique yielding the lowest doses to normal structures.

Results. Nineteen patients were treated with DIBH and three with FB. DIBH reduced the mean estimated lung dose by 2.0 Gy (median: 8.5 Gy vs. 7.2 Gy) (p < 0.01) and the mean heart dose by 1.4 Gy (6.0 Gy vs. 3.9 Gy) (p < 0.01) compared to FB. The lung and heart V20Gy were reduced with a median of 5.3% and 6.3%. Mean doses to the female breasts were equal with FB and DIBH.

Conclusion. DIBH can significantly decrease the estimated mean doses to the heart and lungs without lowering the dose to the target in radiotherapy for patients with mediastinal HL.

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Published

2015-01-02

How to Cite

Petersen, P. M., Aznar, M. C., Berthelsen, A. K., Loft, A., Schut, D. A., Maraldo, M., … Specht, L. (2015). Prospective phase II trial of image-guided radiotherapy in Hodgkin lymphoma: Benefit of deep inspiration breath-hold. Acta Oncologica, 54(1), 60–66. https://doi.org/10.3109/0284186X.2014.932435

Issue

Vol. 54 No. 1 (2015): Acta Oncologica

Section

Articles