Open Access Research

Hodgkin’s lymphoma emerging radiation treatment techniques: trade-offs between late radio-induced toxicities and secondary malignant neoplasms

Laura Cella12, Manuel Conson2, Maria Cristina Pressello3, Silvia Molinelli4, Uwe Schneider5, Vittorio Donato6, Roberto Orecchia7, Marco Salvatore2 and Roberto Pacelli12*

Author Affiliations

1 Institute of Biostructures and Bioimaging, National Council of Research (CNR), Napoli, Italy

2 Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Napoli, Napoli, Italy

3 Department of Health Physics, S. Camillo-Forlanini Hospital, Roma, Italy

4 Unit of Medical Physics, Centro Nazionale di Adroterapia Oncologica Foundation, Pavia, Italy

5 Vetsussie Faculty, University of Zürich and Radiotherapy, Hirslanden, Aarau, Switzerland

6 Department of Radiation Oncology, S. Camillo-Forlanini Hospital, Roma, Italy

7 Advanced Radiotherapy Center, European Institute of Oncology, Milano, Italy

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Radiation Oncology 2013, 8:22  doi:10.1186/1748-717X-8-22

Published: 30 January 2013



Purpose of this study is to explore the trade-offs between radio-induced toxicities and second malignant neoplasm (SMN) induction risk of different emerging radiotherapy techniques for Hodgkin’s lymphoma (HL) through a comprehensive dosimetric analysis on a representative clinical model.


Three different planning target volume (PTVi) scenarios of a female patient with supradiaphragmatic HL were used as models for the purpose of this study. Five treatment radiation techniques were simulated: an anterior-posterior parallel-opposed (AP-PA), a forward intensity modulated (FIMRT), an inverse intensity modulated (IMRT), a Tomotherapy (TOMO), a proton (PRO) technique. A radiation dose of 30 Gy or CGE was prescribed. Dose-volume histograms of PTVs and organs-at-risk (OARs) were calculated and related to available dose-volume constraints. SMN risk for breasts, thyroid, and lungs was estimated through the Organ Equivalent Dose model considering cell repopulation and inhomogeneous organ doses.


With similar level of PTVi coverage, IMRT, TOMO and PRO plans generally reduced the OARs’ dose and accordingly the related radio-induced toxicities. However, only TOMO and PRO plans were compliant with all constraints in all scenarios. For the IMRT and TOMO plans an increased risk of development of breast, and lung SMN compared with AP-PA and FIMRT techniques was estimated. Only PRO plans seemed to reduce the risk of predicted SMN compared with AP-PA technique.


Our model–based study supports the use of advanced RT techniques to successfully spare OARs and to reduce the risk of radio-induced toxicities in HL patients. However, the estimated increase of SMNs’ risk inherent to TOMO and IMRT techniques should be carefully considered in the evaluation of a risk-adapted therapeutic strategy.

Hodgkin’s lymphoma; Emerging radiotherapy techniques; Radio-induced toxicity; Second malignant neoplasm