Doses to carotid arteries after modern radiation therapy for hodgkin lymphoma: Is stroke still a late effect of treatment?

Maja V. Maraldo, Nils P. Brodin, Marianne C. Aznar, Ivan R. Vogelius, Per Munck Af Rosenschöld, Peter M. Petersen, Lena Specht

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose Hodgkin lymphoma (HL) survivors are at an increased risk of stroke because of carotid artery irradiation. However, for early-stage HL involved node radiation therapy (INRT) reduces the volume of normal tissue exposed to high doses. Here, we evaluate 3-dimensional conformal radiation therapy (3D-CRT), volumetric-modulated arc therapy (VMAT), and proton therapy (PT) delivered as INRT along with the extensive mantle field (MF) by comparing doses to the carotid arteries and corresponding risk estimates. Methods and Materials We included a cohort of 46 supradiaphragmatic stage I-II classical HL patients. All patients were initially treated with chemotherapy and INRT delivered as 3D-CRT (30 Gy). For each patient, we simulated MF (36 Gy) and INRT plans using VMAT and PT (30 Gy). Linear dose-response curves for the 20-, 25-, and 30-year risk of stroke were derived from published HL data. Risks of stroke with each technique were calculated for all patients. Statistical analyses were performed with repeated measures analysis of variance. Results The mean doses to the right and left common carotid artery were significantly lower with modern treatment compared with MF, with substantial patient variability. The estimated excess risk of stroke after 20, 25, and 30 years was 0.6%, 0.86%, and 1.3% for 3D-CRT; 0.67%, 0.96%, and 1.47% for VMAT; 0.61%, 0.96%, and 1.33% for PT; and 1.3%, 1.72%, and 2.61% for MF. Conclusions INRT reduces the dose delivered to the carotid arteries and corresponding estimated risk of stroke for HL survivors. Even for the subset of patients with lymphoma close to the carotid arteries, the estimated risk is low.

Original languageEnglish (US)
Pages (from-to)297-303
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume87
Issue number2
DOIs
StatePublished - Oct 1 2013
Externally publishedYes

Fingerprint

arteries
strokes
Hodgkin Disease
Carotid Arteries
radiation therapy
Radiotherapy
Stroke
therapy
dosage
Proton Therapy
Intensity-Modulated Radiotherapy
Earth mantle
arcs
Therapeutics
protons
Survivors
analysis of variance
Common Carotid Artery
chemotherapy
set theory

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Doses to carotid arteries after modern radiation therapy for hodgkin lymphoma : Is stroke still a late effect of treatment? / Maraldo, Maja V.; Brodin, Nils P.; Aznar, Marianne C.; Vogelius, Ivan R.; Munck Af Rosenschöld, Per; Petersen, Peter M.; Specht, Lena.

In: International Journal of Radiation Oncology Biology Physics, Vol. 87, No. 2, 01.10.2013, p. 297-303.

Research output: Contribution to journalArticle

Maraldo, Maja V. ; Brodin, Nils P. ; Aznar, Marianne C. ; Vogelius, Ivan R. ; Munck Af Rosenschöld, Per ; Petersen, Peter M. ; Specht, Lena. / Doses to carotid arteries after modern radiation therapy for hodgkin lymphoma : Is stroke still a late effect of treatment?. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 87, No. 2. pp. 297-303.
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title = "Doses to carotid arteries after modern radiation therapy for hodgkin lymphoma: Is stroke still a late effect of treatment?",
abstract = "Purpose Hodgkin lymphoma (HL) survivors are at an increased risk of stroke because of carotid artery irradiation. However, for early-stage HL involved node radiation therapy (INRT) reduces the volume of normal tissue exposed to high doses. Here, we evaluate 3-dimensional conformal radiation therapy (3D-CRT), volumetric-modulated arc therapy (VMAT), and proton therapy (PT) delivered as INRT along with the extensive mantle field (MF) by comparing doses to the carotid arteries and corresponding risk estimates. Methods and Materials We included a cohort of 46 supradiaphragmatic stage I-II classical HL patients. All patients were initially treated with chemotherapy and INRT delivered as 3D-CRT (30 Gy). For each patient, we simulated MF (36 Gy) and INRT plans using VMAT and PT (30 Gy). Linear dose-response curves for the 20-, 25-, and 30-year risk of stroke were derived from published HL data. Risks of stroke with each technique were calculated for all patients. Statistical analyses were performed with repeated measures analysis of variance. Results The mean doses to the right and left common carotid artery were significantly lower with modern treatment compared with MF, with substantial patient variability. The estimated excess risk of stroke after 20, 25, and 30 years was 0.6{\%}, 0.86{\%}, and 1.3{\%} for 3D-CRT; 0.67{\%}, 0.96{\%}, and 1.47{\%} for VMAT; 0.61{\%}, 0.96{\%}, and 1.33{\%} for PT; and 1.3{\%}, 1.72{\%}, and 2.61{\%} for MF. Conclusions INRT reduces the dose delivered to the carotid arteries and corresponding estimated risk of stroke for HL survivors. Even for the subset of patients with lymphoma close to the carotid arteries, the estimated risk is low.",
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T1 - Doses to carotid arteries after modern radiation therapy for hodgkin lymphoma

T2 - Is stroke still a late effect of treatment?

AU - Maraldo, Maja V.

AU - Brodin, Nils P.

AU - Aznar, Marianne C.

AU - Vogelius, Ivan R.

AU - Munck Af Rosenschöld, Per

AU - Petersen, Peter M.

AU - Specht, Lena

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Purpose Hodgkin lymphoma (HL) survivors are at an increased risk of stroke because of carotid artery irradiation. However, for early-stage HL involved node radiation therapy (INRT) reduces the volume of normal tissue exposed to high doses. Here, we evaluate 3-dimensional conformal radiation therapy (3D-CRT), volumetric-modulated arc therapy (VMAT), and proton therapy (PT) delivered as INRT along with the extensive mantle field (MF) by comparing doses to the carotid arteries and corresponding risk estimates. Methods and Materials We included a cohort of 46 supradiaphragmatic stage I-II classical HL patients. All patients were initially treated with chemotherapy and INRT delivered as 3D-CRT (30 Gy). For each patient, we simulated MF (36 Gy) and INRT plans using VMAT and PT (30 Gy). Linear dose-response curves for the 20-, 25-, and 30-year risk of stroke were derived from published HL data. Risks of stroke with each technique were calculated for all patients. Statistical analyses were performed with repeated measures analysis of variance. Results The mean doses to the right and left common carotid artery were significantly lower with modern treatment compared with MF, with substantial patient variability. The estimated excess risk of stroke after 20, 25, and 30 years was 0.6%, 0.86%, and 1.3% for 3D-CRT; 0.67%, 0.96%, and 1.47% for VMAT; 0.61%, 0.96%, and 1.33% for PT; and 1.3%, 1.72%, and 2.61% for MF. Conclusions INRT reduces the dose delivered to the carotid arteries and corresponding estimated risk of stroke for HL survivors. Even for the subset of patients with lymphoma close to the carotid arteries, the estimated risk is low.

AB - Purpose Hodgkin lymphoma (HL) survivors are at an increased risk of stroke because of carotid artery irradiation. However, for early-stage HL involved node radiation therapy (INRT) reduces the volume of normal tissue exposed to high doses. Here, we evaluate 3-dimensional conformal radiation therapy (3D-CRT), volumetric-modulated arc therapy (VMAT), and proton therapy (PT) delivered as INRT along with the extensive mantle field (MF) by comparing doses to the carotid arteries and corresponding risk estimates. Methods and Materials We included a cohort of 46 supradiaphragmatic stage I-II classical HL patients. All patients were initially treated with chemotherapy and INRT delivered as 3D-CRT (30 Gy). For each patient, we simulated MF (36 Gy) and INRT plans using VMAT and PT (30 Gy). Linear dose-response curves for the 20-, 25-, and 30-year risk of stroke were derived from published HL data. Risks of stroke with each technique were calculated for all patients. Statistical analyses were performed with repeated measures analysis of variance. Results The mean doses to the right and left common carotid artery were significantly lower with modern treatment compared with MF, with substantial patient variability. The estimated excess risk of stroke after 20, 25, and 30 years was 0.6%, 0.86%, and 1.3% for 3D-CRT; 0.67%, 0.96%, and 1.47% for VMAT; 0.61%, 0.96%, and 1.33% for PT; and 1.3%, 1.72%, and 2.61% for MF. Conclusions INRT reduces the dose delivered to the carotid arteries and corresponding estimated risk of stroke for HL survivors. Even for the subset of patients with lymphoma close to the carotid arteries, the estimated risk is low.

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