Radiation-induced second malignancies after involved-node radiotherapy with deep-inspiration breath-hold technique for early stage Hodgkin Lymphoma: a dosimetric studyReport as inadecuate




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Radiation Oncology

, 9:58

Clinical Radiation Oncology

Abstract

BackgroundTo estimate the risk of radiation induced second cancers after radiotherapy using deep-inspiration breath-hold DI technique with three-dimensional conformal 3DCRT and volumetric arc therapy VMAT for patients with Hodgkin’s lymphoma HL.

MethodsEarly-stage HL with mediastinal and supraclavicular involvement was studied using an Alderson phantom. A whole body CT was performed and all tissues were delineated. The clinical target volumes and planning target volumes PTV were determined according to the German Hodgkin study group guidelines. Free-breathing FB technique and DI technique were simulated by different safety margins for the PTV definition. In both cases, 30 Gy in 15 fractions was prescribed. Second cancer risk was estimated for various tissues with a second cancer model including fractionation.

ResultsWhen compared with FB-3DCRT, estimated relative life time attributable risk LAR of cancer induction after DI-3DCRT was 0.86, 0.76, 0.94 and 0.92 for breast, lung, esophagus and stomach, respectively. With DI-VMAT, the corresponding values were 2.05, 1.29, 1.01, 0.93, respectively. For breast cancer, the LAR observed with DI-VMAT was not substantially distinguishable from the LAR computed for mantle RT with an administered dose of 40 Gy.

ConclusionsThis study suggests that DI may reduce the LAR of secondary cancers of all OARs and may be a valuable technique when using 3DCRT. Conversely, VMAT may increase substantially the LAR and should be cautiously implemented in clinical practice.

Electronic supplementary materialThe online version of this article doi:10.1186-1748-717X-9-58 contains supplementary material, which is available to authorized users.

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Author: Uwe Schneider - Marcin Sumila - Judith Robotka - Damien Weber - Günther Gruber

Source: https://link.springer.com/







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