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Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial
INTRODUCTION: The German Hodgkin Study Group (GHSG) HD17 trial established the omission of radiotherapy (RT) for patients with early-stage unfavorable Hodgkin lymphoma being PET-negative after 2 cycles of BEACOPP escalated plus 2 cycles of ABVD. This patient group reveals heterogeneity in characteri...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196378/ https://www.ncbi.nlm.nih.gov/pubmed/37213291 http://dx.doi.org/10.3389/fonc.2023.1183906 |
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author | Oertel, Michael Hering, Dominik Baues, Christian Kittel, Christopher Fuchs, Michael Kriz, Jan Kröger, Kai Vordermark, Dirk Herfarth, Klaus Engenhart-Cabillic, Rita Lukas, Peter Haverkamp, Uwe Borchmann, Peter Eich, Hans Theodor |
author_facet | Oertel, Michael Hering, Dominik Baues, Christian Kittel, Christopher Fuchs, Michael Kriz, Jan Kröger, Kai Vordermark, Dirk Herfarth, Klaus Engenhart-Cabillic, Rita Lukas, Peter Haverkamp, Uwe Borchmann, Peter Eich, Hans Theodor |
author_sort | Oertel, Michael |
collection | PubMed |
description | INTRODUCTION: The German Hodgkin Study Group (GHSG) HD17 trial established the omission of radiotherapy (RT) for patients with early-stage unfavorable Hodgkin lymphoma being PET-negative after 2 cycles of BEACOPP escalated plus 2 cycles of ABVD. This patient group reveals heterogeneity in characteristics and disease extent which prompted us to perform a decisive dosimetric analysis according to GHSG risk factors. This may help to tailor RT individually balancing risks and benefits. METHODS: For quality assurance, RT-plans were requested from the treating facilities (n= 141) and analyzed centrally. Dose-volume histograms were scanned either paper-based or digitally to obtain doses to mediastinal organs. These were registered and compared according to GHSG risk factors. RESULTS: Overall, RT plans of 176 patients were requested, 139 of which had dosimetric information on target volumes within the mediastinum. Most of these patients were stage II (92.8%), had no B-symptoms (79.1%) and were aged < 50 years (89.9%). Risk factors were present in 8.6% (extranodal involvement), 31.7% (bulky disease), 46.0% (elevated erythrocyte sedimentation rate) and 64.0% (three involved areas), respectively. The presence of bulky disease significantly affected the mean RT doses to the heart (p=0.005) and to the left lung (median: 11.3 Gy vs. 9.9 Gy; p=0.042) as well as V5 of the right and left lung, respectively (median right lung: 67.4% vs. 51.0%; p=0.011; median left lung: 65.9% vs. 54.2%; p=0.008). Significant differences in similar organs at risk parameters could be found between the sub-cohorts with the presence or absence of extranodal involvement, respectively. In contrast, an elevated erythrocyte sedimentation rate did not deteriorate dosimetry significantly. No association of any risk factor with radiation doses to the female breast was found. CONCLUSION: Pre-chemotherapy risk factors may help to predict potential RT exposure to normal organs and to critically review treatment indication. Individualized risk-benefit evaluations for patients with HL in early-stage unfavorable disease are mandatory. |
format | Online Article Text |
id | pubmed-10196378 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-101963782023-05-20 Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial Oertel, Michael Hering, Dominik Baues, Christian Kittel, Christopher Fuchs, Michael Kriz, Jan Kröger, Kai Vordermark, Dirk Herfarth, Klaus Engenhart-Cabillic, Rita Lukas, Peter Haverkamp, Uwe Borchmann, Peter Eich, Hans Theodor Front Oncol Oncology INTRODUCTION: The German Hodgkin Study Group (GHSG) HD17 trial established the omission of radiotherapy (RT) for patients with early-stage unfavorable Hodgkin lymphoma being PET-negative after 2 cycles of BEACOPP escalated plus 2 cycles of ABVD. This patient group reveals heterogeneity in characteristics and disease extent which prompted us to perform a decisive dosimetric analysis according to GHSG risk factors. This may help to tailor RT individually balancing risks and benefits. METHODS: For quality assurance, RT-plans were requested from the treating facilities (n= 141) and analyzed centrally. Dose-volume histograms were scanned either paper-based or digitally to obtain doses to mediastinal organs. These were registered and compared according to GHSG risk factors. RESULTS: Overall, RT plans of 176 patients were requested, 139 of which had dosimetric information on target volumes within the mediastinum. Most of these patients were stage II (92.8%), had no B-symptoms (79.1%) and were aged < 50 years (89.9%). Risk factors were present in 8.6% (extranodal involvement), 31.7% (bulky disease), 46.0% (elevated erythrocyte sedimentation rate) and 64.0% (three involved areas), respectively. The presence of bulky disease significantly affected the mean RT doses to the heart (p=0.005) and to the left lung (median: 11.3 Gy vs. 9.9 Gy; p=0.042) as well as V5 of the right and left lung, respectively (median right lung: 67.4% vs. 51.0%; p=0.011; median left lung: 65.9% vs. 54.2%; p=0.008). Significant differences in similar organs at risk parameters could be found between the sub-cohorts with the presence or absence of extranodal involvement, respectively. In contrast, an elevated erythrocyte sedimentation rate did not deteriorate dosimetry significantly. No association of any risk factor with radiation doses to the female breast was found. CONCLUSION: Pre-chemotherapy risk factors may help to predict potential RT exposure to normal organs and to critically review treatment indication. Individualized risk-benefit evaluations for patients with HL in early-stage unfavorable disease are mandatory. Frontiers Media S.A. 2023-05-05 /pmc/articles/PMC10196378/ /pubmed/37213291 http://dx.doi.org/10.3389/fonc.2023.1183906 Text en Copyright © 2023 Oertel, Hering, Baues, Kittel, Fuchs, Kriz, Kröger, Vordermark, Herfarth, Engenhart-Cabillic, Lukas, Haverkamp, Borchmann and Eich https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Oncology Oertel, Michael Hering, Dominik Baues, Christian Kittel, Christopher Fuchs, Michael Kriz, Jan Kröger, Kai Vordermark, Dirk Herfarth, Klaus Engenhart-Cabillic, Rita Lukas, Peter Haverkamp, Uwe Borchmann, Peter Eich, Hans Theodor Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial |
title | Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial |
title_full | Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial |
title_fullStr | Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial |
title_full_unstemmed | Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial |
title_short | Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma– a risk stratified analysis of the GHSG HD17 trial |
title_sort | radiation doses to mediastinal organs at risk in early-stage unfavorable hodgkin lymphoma– a risk stratified analysis of the ghsg hd17 trial |
topic | Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10196378/ https://www.ncbi.nlm.nih.gov/pubmed/37213291 http://dx.doi.org/10.3389/fonc.2023.1183906 |
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