The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma

Anni Y S Jorgensen, Maja V. Maraldo, Nils P. Brodin, Marianne C. Aznar, Ivan R. Vogelius, P. M A Rosenschöld, Peter M. Petersen, Lena Specht

Research output: Contribution to journalArticle

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Abstract

Introduction. The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. Material and methods. We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. Results. Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p < 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p < 0.001). Conclusions. The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.

Original languageEnglish (US)
Pages (from-to)1559-1565
Number of pages7
JournalActa Oncologica
Volume52
Issue number7
DOIs
StatePublished - Oct 2013
Externally publishedYes

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Hodgkin Disease
Esophagus
Radiotherapy
Proton Therapy
Intensity-Modulated Radiotherapy
Conformal Radiotherapy
Therapeutics
Esophagitis
Pathologic Constriction
Esophageal Stenosis
Mediastinum
Esophageal Neoplasms
Photons
Survivors
Analysis of Variance
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Jorgensen, A. Y. S., Maraldo, M. V., Brodin, N. P., Aznar, M. C., Vogelius, I. R., Rosenschöld, P. M. A., ... Specht, L. (2013). The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma. Acta Oncologica, 52(7), 1559-1565. https://doi.org/10.3109/0284186X.2013.813636

The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma. / Jorgensen, Anni Y S; Maraldo, Maja V.; Brodin, Nils P.; Aznar, Marianne C.; Vogelius, Ivan R.; Rosenschöld, P. M A; Petersen, Peter M.; Specht, Lena.

In: Acta Oncologica, Vol. 52, No. 7, 10.2013, p. 1559-1565.

Research output: Contribution to journalArticle

Jorgensen, AYS, Maraldo, MV, Brodin, NP, Aznar, MC, Vogelius, IR, Rosenschöld, PMA, Petersen, PM & Specht, L 2013, 'The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma', Acta Oncologica, vol. 52, no. 7, pp. 1559-1565. https://doi.org/10.3109/0284186X.2013.813636
Jorgensen, Anni Y S ; Maraldo, Maja V. ; Brodin, Nils P. ; Aznar, Marianne C. ; Vogelius, Ivan R. ; Rosenschöld, P. M A ; Petersen, Peter M. ; Specht, Lena. / The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma. In: Acta Oncologica. 2013 ; Vol. 52, No. 7. pp. 1559-1565.
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AU - Jorgensen, Anni Y S

AU - Maraldo, Maja V.

AU - Brodin, Nils P.

AU - Aznar, Marianne C.

AU - Vogelius, Ivan R.

AU - Rosenschöld, P. M A

AU - Petersen, Peter M.

AU - Specht, Lena

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N2 - Introduction. The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. Material and methods. We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. Results. Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p < 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p < 0.001). Conclusions. The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.

AB - Introduction. The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. Material and methods. We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. Results. Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p < 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p < 0.001). Conclusions. The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.

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