Open Access Research

Intensity modulated radiotherapy in early stage Hodgkin lymphoma patients: Is it better than three dimensional conformal radiotherapy?

Vitaliana De Sanctis1, Chiara Bolzan2, Marco D’Arienzo3, Stefano Bracci1*, Alessandro Fanelli1, Maria Christina Cox4, Maurizio Valeriani1, Mattia F Osti1, Giuseppe Minniti1, Laura Chiacchiararelli2 and Riccardo Maurizi Enrici1

Author Affiliations

1 Departments of Radiotherapy, Sant’Andrea Hospital, Via di Grottarossa 1035/1039, 00189, Rome, Italy

2 Departments of Medical Physics, Sant’Andrea Hospital, Via di Grottarossa 1035/1039, 00189, Rome, Italy

3 Centro Ricerche Casaccia, Istituto Nazionale di Metrologia delle Radiazioni Ionizzanti, ENEA, Via Anguillarese 301, 00123, Rome, Italy

4 Departments of Hematology, Sant’Andrea Hospital, Via di Grottarossa 1035/1039, 00189, Rome, Italy

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Radiation Oncology 2012, 7:129  doi:10.1186/1748-717X-7-129

Published: 2 August 2012

Abstract

Background

Cure rate of early Hodgkin Lymphoma are high and avoidance of late toxicities is of paramount importance. This comparative study aims to assess the normal tissue sparing capability of intensity-modulated radiation therapy (IMRT) versus standard three-dimensional conformal radiotherapy (3D-CRT) in terms of dose-volume parameters and normal tissue complication probability (NTCP) for different organs at risk in supradiaphragmatic Hodgkin Lymphoma (HL) patients.

Methods

Ten HL patients were actually treated with 3D-CRT and all treatments were then re-planned with IMRT. Dose-volume parameters for thyroid, oesophagus, heart, coronary arteries, lung, spinal cord and breast were evaluated. Dose-volume histograms generated by TPS were analyzed to predict the NTCP for the considered organs at risk, according to different endpoints.

Results

Regarding dose-volume parameters no statistically significant differences were recorded for heart and origin of coronary arteries. We recorded statistically significant lower V30 with IMRT for oesophagus (6.42 vs 0.33, p = 0.02) and lungs (4.7 vs 0.1 p = 0.014 for the left lung and 2.59 vs 0.1 p = 0.017 for the right lung) and lower V20 for spinal cord (17.8 vs 7.2 p = 0.02). Moreover the maximum dose to the spinal cord was lower with IMRT (30.2 vs 19.9, p <0.001). Higher V10 with IMRT for thyroid (64.8 vs 95, p = 0.0019) and V5 for lungs (30.3 vs 44.8, p = 0.03, for right lung and 28.9 vs 48.1, p = 0.001 for left lung) were found, respectively. Higher V5 and V10 for breasts were found with IMRT (V5: 4.14 vs 20.6, p = 0.018 for left breast and 3.3 vs 17, p = 0.059 for right breast; V10: 2.5 vs 13.6 p = 0.035 for left breast and 1.7 vs 11, p = 0.07 for the right breast.) As for the NTCP, our data point out that IMRT is not always likely to significantly increase the NTCP to OARs.

Conclusions

In HL male patients IMRT seems feasible and accurate while for women HL patients IMRT should be used with caution.

Keywords:
Hodgkin; IMRT; 3D-CRT; NTCP