Minimizing late effects for patients with mediastinal Hodgkin lymphoma: Deep inspiration breath-hold, IMRT, or both?

Marianne C. Aznar, Maja V. Maraldo, Deborah A. Schut, Michael Lundemann, Nils P. Brodin, Ivan R. Vogelius, Anne K. Berthelsen, Lena Specht, Peter M. Petersen

Research output: Contribution to journalArticle

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Abstract

Purpose Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and intensity modulated RT (IMRT). The aim of this study was to determine which treatment modality best reduced the combined risk of life-threatening late effects in patients with mediastinal HL. Methods and Materials Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated life years lost attributable to CD and to lung, breast, and thyroid cancer. Results DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P<.001). There was no significant difference between IMRT-FB and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast dose was increased with IMRT regardless of breathing technique. Life years lost was lowest with DIBH and highest with FB. Conclusions In this cohort, 3DCRT-DIBH resulted in lower estimated doses and lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be beneficial for a subgroup of patients.

Original languageEnglish (US)
Pages (from-to)169-174
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume92
Issue number1
DOIs
StatePublished - May 1 2015

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inspiration
Hodgkin Disease
breathing
Respiration
lungs
breast
Breast Neoplasms
dosage
cancer
Lung Neoplasms
Cardiovascular Diseases
Radiotherapy
radiation therapy
Thyroid Neoplasms
Lung
Breast
subgroups
Survivors
Thyroid Gland
planning

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

Cite this

Minimizing late effects for patients with mediastinal Hodgkin lymphoma : Deep inspiration breath-hold, IMRT, or both? / Aznar, Marianne C.; Maraldo, Maja V.; Schut, Deborah A.; Lundemann, Michael; Brodin, Nils P.; Vogelius, Ivan R.; Berthelsen, Anne K.; Specht, Lena; Petersen, Peter M.

In: International Journal of Radiation Oncology Biology Physics, Vol. 92, No. 1, 01.05.2015, p. 169-174.

Research output: Contribution to journalArticle

Aznar, Marianne C. ; Maraldo, Maja V. ; Schut, Deborah A. ; Lundemann, Michael ; Brodin, Nils P. ; Vogelius, Ivan R. ; Berthelsen, Anne K. ; Specht, Lena ; Petersen, Peter M. / Minimizing late effects for patients with mediastinal Hodgkin lymphoma : Deep inspiration breath-hold, IMRT, or both?. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 92, No. 1. pp. 169-174.
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AU - Schut, Deborah A.

AU - Lundemann, Michael

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N2 - Purpose Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and intensity modulated RT (IMRT). The aim of this study was to determine which treatment modality best reduced the combined risk of life-threatening late effects in patients with mediastinal HL. Methods and Materials Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated life years lost attributable to CD and to lung, breast, and thyroid cancer. Results DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P<.001). There was no significant difference between IMRT-FB and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast dose was increased with IMRT regardless of breathing technique. Life years lost was lowest with DIBH and highest with FB. Conclusions In this cohort, 3DCRT-DIBH resulted in lower estimated doses and lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be beneficial for a subgroup of patients.

AB - Purpose Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and intensity modulated RT (IMRT). The aim of this study was to determine which treatment modality best reduced the combined risk of life-threatening late effects in patients with mediastinal HL. Methods and Materials Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated life years lost attributable to CD and to lung, breast, and thyroid cancer. Results DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P<.001). There was no significant difference between IMRT-FB and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast dose was increased with IMRT regardless of breathing technique. Life years lost was lowest with DIBH and highest with FB. Conclusions In this cohort, 3DCRT-DIBH resulted in lower estimated doses and lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be beneficial for a subgroup of patients.

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