Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma

M. V. Maraldo, Nils P. Brodin, M. C. Aznar, I. R. Vogelius, P. Munck af Rosenschöld, P. M. Petersen, L. Specht

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Hodgkin lymphoma (HL) survivors have an increased morbidity and mortality from secondary cancers and cardiovascular disease (CD). We evaluate doses with involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), or proton therapy (PT), compared with the extensive Mantle Field (MF). Patients and methods: For 27 patients with early-stage, mediastinal HL, treated with chemotherapy and INRT delivered as 3D CRT (30 Gy), we simulated an MF (36 Gy), INRT-VMAT and INRT-PT (30 Gy). Dose to the heart, lungs, and breasts, estimated risks of CD, lung (LC) and breast cancer (BC), and corresponding life years lost (LYL) were compared. Results: 3D CRT, VMAT or PT significantly lower the dose to the heart, lungs and breasts and provide lower risk estimates compared with MF, but with substantial patient variability. The risk of CD is not significantly different for 3D CRT versus VMAT. The risk of LC and BC is highest with VMAT. For LYL, PT is the superior modern technique. Conclusions: In early-stage, mediastinal HL modern radiotherapy provides superior results compared with MF. However, there is no single best radiotherapy technique for HL-the decision should be made at the individual patient level.

Original languageEnglish (US)
Pages (from-to)2113-2118
Number of pages6
JournalAnnals of Oncology
Volume24
Issue number8
DOIs
StatePublished - Aug 2013
Externally publishedYes

Fingerprint

Conformal Radiotherapy
Intensity-Modulated Radiotherapy
Hodgkin Disease
Proton Therapy
Cardiovascular Diseases
Radiotherapy
Neoplasms
Breast
Breast Neoplasms
Lung
Survivors
Lung Neoplasms
Morbidity
Drug Therapy
Mortality

Keywords

  • Cardiovascular disease
  • Highly conformal radiotherapy
  • Hodgkin lymphoma
  • Involved node radiotherapy
  • Secondary cancers

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma. / Maraldo, M. V.; Brodin, Nils P.; Aznar, M. C.; Vogelius, I. R.; Munck af Rosenschöld, P.; Petersen, P. M.; Specht, L.

In: Annals of Oncology, Vol. 24, No. 8, 08.2013, p. 2113-2118.

Research output: Contribution to journalArticle

Maraldo, M. V. ; Brodin, Nils P. ; Aznar, M. C. ; Vogelius, I. R. ; Munck af Rosenschöld, P. ; Petersen, P. M. ; Specht, L. / Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma. In: Annals of Oncology. 2013 ; Vol. 24, No. 8. pp. 2113-2118.
@article{6b1b8e44ff6f49a887848747f15ee6ea,
title = "Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma",
abstract = "Hodgkin lymphoma (HL) survivors have an increased morbidity and mortality from secondary cancers and cardiovascular disease (CD). We evaluate doses with involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), or proton therapy (PT), compared with the extensive Mantle Field (MF). Patients and methods: For 27 patients with early-stage, mediastinal HL, treated with chemotherapy and INRT delivered as 3D CRT (30 Gy), we simulated an MF (36 Gy), INRT-VMAT and INRT-PT (30 Gy). Dose to the heart, lungs, and breasts, estimated risks of CD, lung (LC) and breast cancer (BC), and corresponding life years lost (LYL) were compared. Results: 3D CRT, VMAT or PT significantly lower the dose to the heart, lungs and breasts and provide lower risk estimates compared with MF, but with substantial patient variability. The risk of CD is not significantly different for 3D CRT versus VMAT. The risk of LC and BC is highest with VMAT. For LYL, PT is the superior modern technique. Conclusions: In early-stage, mediastinal HL modern radiotherapy provides superior results compared with MF. However, there is no single best radiotherapy technique for HL-the decision should be made at the individual patient level.",
keywords = "Cardiovascular disease, Highly conformal radiotherapy, Hodgkin lymphoma, Involved node radiotherapy, Secondary cancers",
author = "Maraldo, {M. V.} and Brodin, {Nils P.} and Aznar, {M. C.} and Vogelius, {I. R.} and {Munck af Rosensch{\"o}ld}, P. and Petersen, {P. M.} and L. Specht",
year = "2013",
month = "8",
doi = "10.1093/annonc/mdt156",
language = "English (US)",
volume = "24",
pages = "2113--2118",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma

AU - Maraldo, M. V.

AU - Brodin, Nils P.

AU - Aznar, M. C.

AU - Vogelius, I. R.

AU - Munck af Rosenschöld, P.

AU - Petersen, P. M.

AU - Specht, L.

PY - 2013/8

Y1 - 2013/8

N2 - Hodgkin lymphoma (HL) survivors have an increased morbidity and mortality from secondary cancers and cardiovascular disease (CD). We evaluate doses with involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), or proton therapy (PT), compared with the extensive Mantle Field (MF). Patients and methods: For 27 patients with early-stage, mediastinal HL, treated with chemotherapy and INRT delivered as 3D CRT (30 Gy), we simulated an MF (36 Gy), INRT-VMAT and INRT-PT (30 Gy). Dose to the heart, lungs, and breasts, estimated risks of CD, lung (LC) and breast cancer (BC), and corresponding life years lost (LYL) were compared. Results: 3D CRT, VMAT or PT significantly lower the dose to the heart, lungs and breasts and provide lower risk estimates compared with MF, but with substantial patient variability. The risk of CD is not significantly different for 3D CRT versus VMAT. The risk of LC and BC is highest with VMAT. For LYL, PT is the superior modern technique. Conclusions: In early-stage, mediastinal HL modern radiotherapy provides superior results compared with MF. However, there is no single best radiotherapy technique for HL-the decision should be made at the individual patient level.

AB - Hodgkin lymphoma (HL) survivors have an increased morbidity and mortality from secondary cancers and cardiovascular disease (CD). We evaluate doses with involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), or proton therapy (PT), compared with the extensive Mantle Field (MF). Patients and methods: For 27 patients with early-stage, mediastinal HL, treated with chemotherapy and INRT delivered as 3D CRT (30 Gy), we simulated an MF (36 Gy), INRT-VMAT and INRT-PT (30 Gy). Dose to the heart, lungs, and breasts, estimated risks of CD, lung (LC) and breast cancer (BC), and corresponding life years lost (LYL) were compared. Results: 3D CRT, VMAT or PT significantly lower the dose to the heart, lungs and breasts and provide lower risk estimates compared with MF, but with substantial patient variability. The risk of CD is not significantly different for 3D CRT versus VMAT. The risk of LC and BC is highest with VMAT. For LYL, PT is the superior modern technique. Conclusions: In early-stage, mediastinal HL modern radiotherapy provides superior results compared with MF. However, there is no single best radiotherapy technique for HL-the decision should be made at the individual patient level.

KW - Cardiovascular disease

KW - Highly conformal radiotherapy

KW - Hodgkin lymphoma

KW - Involved node radiotherapy

KW - Secondary cancers

UR - http://www.scopus.com/inward/record.url?scp=84881239116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881239116&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdt156

DO - 10.1093/annonc/mdt156

M3 - Article

VL - 24

SP - 2113

EP - 2118

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 8

ER -