Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma

PURPOSE: High cure rates for Hodgkin’s lymphoma must be balanced with long-term treatment-related toxicity. Here we report an intensity-modulated radiation therapy (IMRT) technique that achieves adequate target coverage for mediastinal disease while minimizing high- and low-dose exposure of critical...

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Autores principales: Voong, Khinh Ranh, McSpadden, Kelli, Pinnix, Chelsea C, Shihadeh, Ferial, Reed, Valerie, Salehpour, Mohammad R, Arzu, Isidora, Wang, He, Hodgson, David, Garcia, John, Aristophanous, Michalis, Dabaja, Bouthaina S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013438/
https://www.ncbi.nlm.nih.gov/pubmed/24735767
http://dx.doi.org/10.1186/1748-717X-9-94
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author Voong, Khinh Ranh
McSpadden, Kelli
Pinnix, Chelsea C
Shihadeh, Ferial
Reed, Valerie
Salehpour, Mohammad R
Arzu, Isidora
Wang, He
Hodgson, David
Garcia, John
Aristophanous, Michalis
Dabaja, Bouthaina S
author_facet Voong, Khinh Ranh
McSpadden, Kelli
Pinnix, Chelsea C
Shihadeh, Ferial
Reed, Valerie
Salehpour, Mohammad R
Arzu, Isidora
Wang, He
Hodgson, David
Garcia, John
Aristophanous, Michalis
Dabaja, Bouthaina S
author_sort Voong, Khinh Ranh
collection PubMed
description PURPOSE: High cure rates for Hodgkin’s lymphoma must be balanced with long-term treatment-related toxicity. Here we report an intensity-modulated radiation therapy (IMRT) technique that achieves adequate target coverage for mediastinal disease while minimizing high- and low-dose exposure of critical organs. METHODS AND MATERIALS: Treatment plans for IMRT and conventional anteroposterior-posteroanterior (AP-PA) techniques, with comparable coverage of the planning target volume (PTV), were generated for 9 female patients with mediastinal Hodgkin’s lymphoma assuming use of inclined positioning, daily breath-hold, and CT-on-rails verification. Our “butterfly” IMRT beam arrangement involved anterior beams of 300°−30° and posterior beams of 160°−210°. Percentages of normal structures receiving 30 Gy (V(30)), 20 Gy (V(20)), and 5 Gy (V(5)) were tabulated for the right and left breasts, total lung, heart, left and right ventricles, left anterior descending coronary artery (LAD), and spinal cord. Differences in each variable, conformity index, homogeneity index, and V(107%) between the two techniques were calculated (IMRT minus conventional). RESULTS: Use of IMRT generally reduced the V(30) and V(20) to critical structures: −1.4% and +0.1% to the right breast, −1.7% and −0.9% to the left breast, −14.6% and −7.7% to the total lung, −12.2% and −10.5% to the heart, −2.4% and −14.2% to the left ventricle, −16.4% and −8.4% to the right ventricle, −7.0% and −14.2% to the LAD, and −52.2% and −13.4% to the spinal cord. Differences in V(5) were +6.2% for right breast, +2.8% for left breast, +12.9% for total lung, −3.5% for heart, −8.2% for left ventricle, −1.5% for right ventricle, +0.1% for LAD, and −0.1% for spinal cord. Use of IMRT significantly reduced the volume of tissue receiving 107% of the dose (mean 754 cm(3) reduction). CONCLUSIONS: This butterfly technique for IMRT avoids excess exposure of heart, breast, lung, and spinal cord to doses of 30 or 20 Gy; mildly increases V(5) to the breasts; and decreases the V(107%).
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spelling pubmed-40134382014-05-09 Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma Voong, Khinh Ranh McSpadden, Kelli Pinnix, Chelsea C Shihadeh, Ferial Reed, Valerie Salehpour, Mohammad R Arzu, Isidora Wang, He Hodgson, David Garcia, John Aristophanous, Michalis Dabaja, Bouthaina S Radiat Oncol Research PURPOSE: High cure rates for Hodgkin’s lymphoma must be balanced with long-term treatment-related toxicity. Here we report an intensity-modulated radiation therapy (IMRT) technique that achieves adequate target coverage for mediastinal disease while minimizing high- and low-dose exposure of critical organs. METHODS AND MATERIALS: Treatment plans for IMRT and conventional anteroposterior-posteroanterior (AP-PA) techniques, with comparable coverage of the planning target volume (PTV), were generated for 9 female patients with mediastinal Hodgkin’s lymphoma assuming use of inclined positioning, daily breath-hold, and CT-on-rails verification. Our “butterfly” IMRT beam arrangement involved anterior beams of 300°−30° and posterior beams of 160°−210°. Percentages of normal structures receiving 30 Gy (V(30)), 20 Gy (V(20)), and 5 Gy (V(5)) were tabulated for the right and left breasts, total lung, heart, left and right ventricles, left anterior descending coronary artery (LAD), and spinal cord. Differences in each variable, conformity index, homogeneity index, and V(107%) between the two techniques were calculated (IMRT minus conventional). RESULTS: Use of IMRT generally reduced the V(30) and V(20) to critical structures: −1.4% and +0.1% to the right breast, −1.7% and −0.9% to the left breast, −14.6% and −7.7% to the total lung, −12.2% and −10.5% to the heart, −2.4% and −14.2% to the left ventricle, −16.4% and −8.4% to the right ventricle, −7.0% and −14.2% to the LAD, and −52.2% and −13.4% to the spinal cord. Differences in V(5) were +6.2% for right breast, +2.8% for left breast, +12.9% for total lung, −3.5% for heart, −8.2% for left ventricle, −1.5% for right ventricle, +0.1% for LAD, and −0.1% for spinal cord. Use of IMRT significantly reduced the volume of tissue receiving 107% of the dose (mean 754 cm(3) reduction). CONCLUSIONS: This butterfly technique for IMRT avoids excess exposure of heart, breast, lung, and spinal cord to doses of 30 or 20 Gy; mildly increases V(5) to the breasts; and decreases the V(107%). BioMed Central 2014-04-15 /pmc/articles/PMC4013438/ /pubmed/24735767 http://dx.doi.org/10.1186/1748-717X-9-94 Text en Copyright © 2014 Voong et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Voong, Khinh Ranh
McSpadden, Kelli
Pinnix, Chelsea C
Shihadeh, Ferial
Reed, Valerie
Salehpour, Mohammad R
Arzu, Isidora
Wang, He
Hodgson, David
Garcia, John
Aristophanous, Michalis
Dabaja, Bouthaina S
Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma
title Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma
title_full Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma
title_fullStr Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma
title_full_unstemmed Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma
title_short Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma
title_sort dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal hodgkin’s lymphoma
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013438/
https://www.ncbi.nlm.nih.gov/pubmed/24735767
http://dx.doi.org/10.1186/1748-717X-9-94
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