The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma

M. V. Maraldo, M. Jørgensen, Nils P. Brodin, M. C. Aznar, I. R. Vogelius, P. M. Petersen, A. K. Berthelsen, C. B. Christensen, L. L. Hjalgrim, L. Specht

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: The use of radiotherapy (RT) is debated for pediatric patients with Hodgkin lymphoma (HL) due to the late effects of treatment. Radiation doses to the thyroid, heart, lungs, and breasts are compared with the extensive mantle field (MF), Involved Field RT (IFRT), Modified IFRT (mIFRT), and Involved Node RT (INRT) and the risk of radiation-induced cardiovascular disease, secondary cancers, and the corresponding Life Years Lost (LYL) is estimated with each technique. Procedure: INRT, mIFRT, IFRT, and MF plans (20 and 30Gy) were simulated for 10 supradiaphragmatic, clinical stage I-II classical HL patients ≤18 years old, total of 4×2 plans for each patient. The lifetime excess risks of cardiac morbidity, cardiac mortality, lung, breast, and thyroid cancer with each technique were estimated. The estimated excess risks attributable to RT were based on HL series with long-term follow-up, treating death from other causes as competing risks. The corresponding LYL were derived from the estimated excess risks. Statistical analyses were performed with repeated measures ANOVA. Results: Both a reduction in field size and in prescribed radiation dose significantly lowered the estimated dose to the heart, lungs, breasts, and thyroid compared to past, extended fields, even for patients with mediastinal disease. This translated into a significantly reduced estimated risk of cardiovascular disease, secondary cancers, and LYL. Conclusions: Involved Node Radiotherapy should be considered for pediatric patients with Hodgkin lymphoma since it is estimated to substantially lower the risk of severe long-term complications. Pediatr Blood Cancer 2014;61:717-722.

Original languageEnglish (US)
Pages (from-to)717-722
Number of pages6
JournalPediatric Blood and Cancer
Volume61
Issue number4
DOIs
StatePublished - Apr 2014

Fingerprint

Hodgkin Disease
Radiotherapy
Radiation
Pediatrics
Thyroid Gland
Breast
Cardiovascular Diseases
Mediastinal Diseases
Neoplasms
Lung
Heart Neoplasms
Thyroid Neoplasms
Cause of Death
Lung Neoplasms
Analysis of Variance
Breast Neoplasms
Morbidity
Mortality

Keywords

  • Hodgkin lymphoma
  • Late effects
  • Long-term survival
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma. / Maraldo, M. V.; Jørgensen, M.; Brodin, Nils P.; Aznar, M. C.; Vogelius, I. R.; Petersen, P. M.; Berthelsen, A. K.; Christensen, C. B.; Hjalgrim, L. L.; Specht, L.

In: Pediatric Blood and Cancer, Vol. 61, No. 4, 04.2014, p. 717-722.

Research output: Contribution to journalArticle

Maraldo, MV, Jørgensen, M, Brodin, NP, Aznar, MC, Vogelius, IR, Petersen, PM, Berthelsen, AK, Christensen, CB, Hjalgrim, LL & Specht, L 2014, 'The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma', Pediatric Blood and Cancer, vol. 61, no. 4, pp. 717-722. https://doi.org/10.1002/pbc.24861
Maraldo, M. V. ; Jørgensen, M. ; Brodin, Nils P. ; Aznar, M. C. ; Vogelius, I. R. ; Petersen, P. M. ; Berthelsen, A. K. ; Christensen, C. B. ; Hjalgrim, L. L. ; Specht, L. / The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma. In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 4. pp. 717-722.
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abstract = "Background: The use of radiotherapy (RT) is debated for pediatric patients with Hodgkin lymphoma (HL) due to the late effects of treatment. Radiation doses to the thyroid, heart, lungs, and breasts are compared with the extensive mantle field (MF), Involved Field RT (IFRT), Modified IFRT (mIFRT), and Involved Node RT (INRT) and the risk of radiation-induced cardiovascular disease, secondary cancers, and the corresponding Life Years Lost (LYL) is estimated with each technique. Procedure: INRT, mIFRT, IFRT, and MF plans (20 and 30Gy) were simulated for 10 supradiaphragmatic, clinical stage I-II classical HL patients ≤18 years old, total of 4×2 plans for each patient. The lifetime excess risks of cardiac morbidity, cardiac mortality, lung, breast, and thyroid cancer with each technique were estimated. The estimated excess risks attributable to RT were based on HL series with long-term follow-up, treating death from other causes as competing risks. The corresponding LYL were derived from the estimated excess risks. Statistical analyses were performed with repeated measures ANOVA. Results: Both a reduction in field size and in prescribed radiation dose significantly lowered the estimated dose to the heart, lungs, breasts, and thyroid compared to past, extended fields, even for patients with mediastinal disease. This translated into a significantly reduced estimated risk of cardiovascular disease, secondary cancers, and LYL. Conclusions: Involved Node Radiotherapy should be considered for pediatric patients with Hodgkin lymphoma since it is estimated to substantially lower the risk of severe long-term complications. Pediatr Blood Cancer 2014;61:717-722.",
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T1 - The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma

AU - Maraldo, M. V.

AU - Jørgensen, M.

AU - Brodin, Nils P.

AU - Aznar, M. C.

AU - Vogelius, I. R.

AU - Petersen, P. M.

AU - Berthelsen, A. K.

AU - Christensen, C. B.

AU - Hjalgrim, L. L.

AU - Specht, L.

PY - 2014/4

Y1 - 2014/4

N2 - Background: The use of radiotherapy (RT) is debated for pediatric patients with Hodgkin lymphoma (HL) due to the late effects of treatment. Radiation doses to the thyroid, heart, lungs, and breasts are compared with the extensive mantle field (MF), Involved Field RT (IFRT), Modified IFRT (mIFRT), and Involved Node RT (INRT) and the risk of radiation-induced cardiovascular disease, secondary cancers, and the corresponding Life Years Lost (LYL) is estimated with each technique. Procedure: INRT, mIFRT, IFRT, and MF plans (20 and 30Gy) were simulated for 10 supradiaphragmatic, clinical stage I-II classical HL patients ≤18 years old, total of 4×2 plans for each patient. The lifetime excess risks of cardiac morbidity, cardiac mortality, lung, breast, and thyroid cancer with each technique were estimated. The estimated excess risks attributable to RT were based on HL series with long-term follow-up, treating death from other causes as competing risks. The corresponding LYL were derived from the estimated excess risks. Statistical analyses were performed with repeated measures ANOVA. Results: Both a reduction in field size and in prescribed radiation dose significantly lowered the estimated dose to the heart, lungs, breasts, and thyroid compared to past, extended fields, even for patients with mediastinal disease. This translated into a significantly reduced estimated risk of cardiovascular disease, secondary cancers, and LYL. Conclusions: Involved Node Radiotherapy should be considered for pediatric patients with Hodgkin lymphoma since it is estimated to substantially lower the risk of severe long-term complications. Pediatr Blood Cancer 2014;61:717-722.

AB - Background: The use of radiotherapy (RT) is debated for pediatric patients with Hodgkin lymphoma (HL) due to the late effects of treatment. Radiation doses to the thyroid, heart, lungs, and breasts are compared with the extensive mantle field (MF), Involved Field RT (IFRT), Modified IFRT (mIFRT), and Involved Node RT (INRT) and the risk of radiation-induced cardiovascular disease, secondary cancers, and the corresponding Life Years Lost (LYL) is estimated with each technique. Procedure: INRT, mIFRT, IFRT, and MF plans (20 and 30Gy) were simulated for 10 supradiaphragmatic, clinical stage I-II classical HL patients ≤18 years old, total of 4×2 plans for each patient. The lifetime excess risks of cardiac morbidity, cardiac mortality, lung, breast, and thyroid cancer with each technique were estimated. The estimated excess risks attributable to RT were based on HL series with long-term follow-up, treating death from other causes as competing risks. The corresponding LYL were derived from the estimated excess risks. Statistical analyses were performed with repeated measures ANOVA. Results: Both a reduction in field size and in prescribed radiation dose significantly lowered the estimated dose to the heart, lungs, breasts, and thyroid compared to past, extended fields, even for patients with mediastinal disease. This translated into a significantly reduced estimated risk of cardiovascular disease, secondary cancers, and LYL. Conclusions: Involved Node Radiotherapy should be considered for pediatric patients with Hodgkin lymphoma since it is estimated to substantially lower the risk of severe long-term complications. Pediatr Blood Cancer 2014;61:717-722.

KW - Hodgkin lymphoma

KW - Late effects

KW - Long-term survival

KW - Radiotherapy

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