1
|
Rosenbrock J, Kaul H, Oertel M, Celik E, Linde P, Fan J, Eichenauer DA, Bröckelmann PJ, von Tresckow B, Kobe C, Dietlein M, Fuchs M, Borchmann P, Eich HT, Baues C. Involved-site Radiation Therapy is Equally Effective and Less Toxic Than Involved-field Radiation Therapy in Patients Receiving Combined Modality Treatment for Early-stage Unfavorable Hodgkin Lymphoma-An Analysis of the Randomized Phase 3 HD17 Trial of the German Hodgkin Study Group. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00514-5. [PMID: 38631539 DOI: 10.1016/j.ijrobp.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Combined modality treatment with chemotherapy followed by consolidation radiation therapy (RT) provides excellent outcomes for patients with early-stage Hodgkin lymphoma. The international standard of care for consolidation RT, involved-site/involved-node radiation therapy (ISRT/INRT), has never been evaluated in a randomized phase 3 trial against the former standard involved-field radiation therapy (IFRT). METHODS AND MATERIALS In the multicenter phase 3 GHSG (German Hodgkin Study Group) HD17 trial, patients with early-stage unfavorable Hodgkin lymphoma were randomized between the standard Combined modality treatment group and a positron-emission tomography (PET)-guided group. In the standard group, patients received 2 cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (eBEACOPP) and 2 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by 30 Gy IFRT. In the experimental group, patients received no further therapy if postchemotherapy PET was negative and 30 Gy GHSG INRT, comparable to and therefore termed here ISRT, if PET was positive. Here, we analyze the interim PET-positive patients in a post hoc analysis, and therefore the randomized comparison of IFRT versus INRT/ISRT. RESULTS A total of 1100 patients were randomized, of which 311 had a positive PET after chemotherapy. Kaplan-Meier estimates of 4-year progression-free survival were 96.8% (95% CI, 91.6%-98.8%) in the IFRT group and 95.4% (95% CI, 89.9%-97.9%; HR, 1.40; 95% CI, 0.44-4.42) in the ISRT group. The pattern of recurrence analyses indicated that none of the cases of disease progression or recurrence in the ISRT group would have been prevented by the use of IFRT. Acute grade 3/4 toxicities occurred in 8.5% of IFRT patients and 2.6% of ISRT patients (P = .03). CONCLUSIONS For the first time, consolidation INRT/ISRT was randomly compared with IFRT in a phase 3 trial. Regarding progression-free survival, no advantage of IFRT could be demonstrated. In summary, our data confirm the status of INRT/ISRT as the current standard of care.
Collapse
Affiliation(s)
- Johannes Rosenbrock
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Helen Kaul
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Michael Oertel
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Linde
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jiaqi Fan
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Paul J Bröckelmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG); Department of Hematology and Stem Cell Transplantation, West German Cancer Center (WTZ), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Carsten Kobe
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Markus Dietlein
- German Hodgkin Study Group (GHSG); Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG); Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Hans Theodor Eich
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Christian Baues
- German Hodgkin Study Group (GHSG); Department of Radiation Oncology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
2
|
Galunic Bilic L, Santek F, Mitrovic Z, Basic-Kinda S, Dujmovic D, Vodanovic M, Mandac Smoljanovic I, Ostojic Kolonic S, Galunic Cicak R, Aurer I. Long-Term Results of IFRT vs. ISRT in Infradiaphragmal Fields in Aggressive Non-Hodgkins's Lymphoma Patients-A Single Centre Experience. Cancers (Basel) 2024; 16:649. [PMID: 38339400 PMCID: PMC10854861 DOI: 10.3390/cancers16030649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/19/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: This study aimed to examine the difference in efficacy and toxicity of involved-field (IFRT) and involved-site radiotherapy (ISRT) fields in infradiaphragmal aggressive non-Hodgkin lymphoma patients. (2) Methods: In total, 140 patients with infradiaphragmal lymphoma treated between 2003 and 2020 were retrospectively evaluated. There were 69 patients (49%) treated with IFRT, and 71 (51%) patients treated with ISRT. The median dose in the IFRT group was 36 Gy, (range 4-50.4 Gy), and in the ISRT group, it was 30 Gy (range 4-48 Gy). (3) Results: The median follow-up in the IFRT group was 133 months (95% CI 109-158), and in the ISRT group, it was 48 months (95% CI 39-57). In the IFRT group, locoregional control was 67%, and in the ISRT group, 73%. The 2- and 5-year overall survival (OS) in the IFRT and ISRT groups were 79% and 69% vs. 80% and 70%, respectively (p = 0.711). The 2- and 5-year event-free survival (EFS) in the IFRT and ISRT groups were 73% and 68% vs. 77% and 70%, respectively (p = 0.575). Acute side effects occurred in 43 (31%) patients, which is more frequent in the IFRT group, 34 (39%) patients, than in the ISRT group, 9 (13%) patients, p > 0.01. Late toxicities occurred more often in the IFRT group of patients, (10/53) 19%, than in the ISRT group of patients, (2/37) 5%, (p = 0.026). (4) Conclusions: By reducing the radiotherapy volume and the doses in the treatment of infradiaphragmatic fields, treatment with significantly fewer acute and long-term side effects is possible. At the same time, efficiency and local disease control are not compromised.
Collapse
Affiliation(s)
- Lea Galunic Bilic
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Fedor Santek
- Department of Oncology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
| | - Zdravko Mitrovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Sandra Basic-Kinda
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Dino Dujmovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Marijo Vodanovic
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| | - Inga Mandac Smoljanovic
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, Clinical Hospital Merkur, 10000 Zagreb, Croatia;
| | - Ruzica Galunic Cicak
- Department of Radiology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Igor Aurer
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (Z.M.); (S.O.K.); (I.A.)
- Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (S.B.-K.); (D.D.); (M.V.)
| |
Collapse
|
3
|
Yilmaz MT, Kamer S, Agaoglu F, Hayran KM, Yildiz F. Involved-site Radiotherapy Delineation Dilemmas in the Treatment of Adult Hodgkin Lymphoma: Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology and TBI Study Group Case-based Questionnaire Review (TROD 03-005). Clin Oncol (R Coll Radiol) 2024; 36:80-86. [PMID: 38042670 DOI: 10.1016/j.clon.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
AIMS The International Lymphoma Radiation Oncology Group (ILROG) defined involved-site radiotherapy (ISRT) guidelines. These rules offer a certain variability that allows for autonomous decision-making in diverse clinical settings. However, this flexibility also gives rise to conflicts about the selection of treatment fields in the daily decision-making process. The aim of this study was to show the extent of interobserver variability when ILROG-ISRT recommendations were used in different clinical scenarios. MATERIALS AND METHODS The 10-question survey used in our study consisted of two parts (part A and part B) and was prepared by four senior radiation oncologists experienced in the haemato-oncology field. The results were presented by stratifying according to clinical experience (<10 years, ≥10 years). Binomial tests (one-sided) were conducted to assess whether answers for each group and the whole group reached a consensus. RESULTS Twenty-six radiation oncologists, 13 of whom had less than 10 years of experience and 13 seniors, participated in the survey. Eighty per cent of respondents thought ILROG did not bring sufficient solutions for all clinical scenarios but offered solutions in some cases. In different case-based scenarios, the consensus among the respondents decreased down to 38%. Senior radiation oncologists were found to have more doubts about the adequacy of current guidelines. CONCLUSIONS ILROG guidelines allow for a high degree of variability in real-life clinical scenarios and different interpretation of the recommendations may lead to increased toxicity and recurrences. Therefore, there is a need for refinement in ISRT delineation strategies. On behalf of the Turkish Society for Radiation Oncology Hematological Oncology, Pediatric Oncology and TBI Study Group, we are planning to carry out further educational contouring sessions to detect the interobserver variability in real-life contouring cases.
Collapse
Affiliation(s)
- M T Yilmaz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Kamer
- Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
| | - F Agaoglu
- Department of Radiation Oncology, Acibadem Mehmet Aydinlar University Faculty of Medicine, Istanbul, Turkey
| | - K M Hayran
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - F Yildiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| |
Collapse
|
4
|
Shankar A, Hall GW, McKay P, Gallop-Evans E, Fielding P, Collins GP. Management of children and adults with all stages of nodular lymphocyte predominant Hodgkin lymphoma - All StAGEs: A consensus-based position paper from the Hodgkin lymphoma subgroup of the UK National Cancer Research Institute. Br J Haematol 2022; 197:679-690. [PMID: 35362554 DOI: 10.1111/bjh.18169] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022]
Abstract
A consensus statement for the management for patients of all ages with all stages of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) - All StAGEs - is proposed by representatives of the UK National Cancer Research Institute (NCRI) Hodgkin lymphoma study group and the Children's Cancer & Leukaemia Group. Based on current practices and published evidence, a consensus has been reached regarding diagnosis, staging and risk-ik7 stratified management which includes active surveillance, low- and standard-dose immunochemotherapy and radiotherapy.
Collapse
Affiliation(s)
- Ananth Shankar
- Children and Young People's Cancer Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgina W Hall
- Paediatric & Adolescent Haematology/Oncology unit, Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pam McKay
- Department of Haematology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Eve Gallop-Evans
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Patrick Fielding
- Wales Research and Diagnostic PET Imaging Centre, Department of Radiology, Cardiff, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
5
|
Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Chen W, Dabaja B, Daly ME, Gordon LI, Hansen N, Herrera AF, Hochberg EP, Johnston PB, Kaminski MS, Kelsey CR, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, Metzger M, Morgan D, Mulroney C, Pullarkat ST, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Torka P, Winter JN, Yahalom J, Yang JC, Burns JL, Campbell M, Sundar H. NCCN Guidelines® Insights: Hodgkin Lymphoma, Version 2.2022. J Natl Compr Canc Netw 2022; 20:322-334. [PMID: 35390768 DOI: 10.6004/jnccn.2022.0021] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon malignancy of B-cell origin. Classical HL (cHL) and nodular lymphocyte-predominant HL are the 2 main types of HL. The cure rates for HL have increased so markedly with the advent of modern treatment options that overriding treatment considerations often relate to long-term toxicity. These NCCN Guidelines Insights discuss the recent updates to the NCCN Guidelines for HL focusing on (1) radiation therapy dose constraints in the management of patients with HL, and (2) the management of advanced-stage and relapsed or refractory cHL.
Collapse
Affiliation(s)
| | | | - Weiyun Z Ai
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Weina Chen
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | - Leo I Gordon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | | | | | | | | | - Ryan C Lynch
- Fred Hutchinson Cancer Research Center/University of Washington
| | - Kami Maddocks
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Monika Metzger
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | | | - Randa Tao
- Huntsman Cancer Institute at the University of Utah
| | | | - Jane N Winter
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Joanna C Yang
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; and
| | | | | | | |
Collapse
|
6
|
PET imaging of lymphomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
7
|
Abstract
Radiotherapy for Hodgkin lymphomas has evolved a lot over time, but still plays an important role, almost always in addition to chemotherapy, for the management of the early stages. The major objective is to preserve the quality of life of patients who will be cured from this disease in the vast majority of cases. Also, the personalization of the indications for the purpose of de-escalating toxicity is very refined and is essentially based on the pre- and pertherapeutic assessment by FDG-PET. The indications for radiotherapy are more limited for non-Hodgkin lymphomas, but the same principles are found, regardless of the histological type. We present the update of the recommendations of the French society of oncological radiotherapy for radiotherapy of lymphomas, which remains a very evolving field in terms of therapeutic strategy and evaluation.
Collapse
|
8
|
Jia J, Chen W. Role of radiation therapy in primary tonsil large B cell lymphoma: a SEER-based analysis. Radiat Oncol 2021; 16:193. [PMID: 34600539 PMCID: PMC8487472 DOI: 10.1186/s13014-021-01919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Backgroud Primary tonsil diffuse large B cell lymphoma (PT-DLBCL) is an uncommon disease entity. The role of radiation therapy (RT) in PT-DLBCL is debatable in both the pre- and post- rituximab era. The purpose of this study was to evaluate the treatment outcome and establish a prognostic model in PT-DLBCL based on the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods Data of 1214 PT-DLBCL patients diagnosed between 1975 and 2016 were extracted from SEER 18. The effect of RT was assessed for the entire cohort and subgroups by stages using univariate, multivariate Cox regression analyses and propensity score matching (PSM). Results The entire cohort included 1043 patients with early-stage (ES) PT-DLBCL and 171 patients with advanced-stage (AS) disease. A decreasing trend of RT utilization in the ES cohort after 2002 was observed. 47.4% of patients in ES received RT, whereas 25.1% in AS underwent RT. RT significantly improved overall survival in both univariate (P < 0.001) and multivariate (P = 0.002) analyses. PSM analysis further validated the survival advantage of RT (P = 0.002). A nomogram was established to predict the potential survival benefit. Subgroup analysis revealed RT was significantly associated with overall survival in ES patients of PT-DLBCL (P = 0.001) and in the rituximab era (P = 0.001) but not in those with AS disease (P = 0.241). Conclusions This population-based study encloses the largest sample of PT-DLBCL to date and demonstrates a favorable survival role of RT in early stages rather than advanced stages. The established nomogram helps to identify high risk patients to improve prognosis.
Collapse
Affiliation(s)
- Jing Jia
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
9
|
Jefferies JL, Mazur WM, Howell CR, Plana JC, Ness KK, Li Z, Joshi VM, Green DM, Mulrooney DA, Towbin JA, Martinez HR, Goldberg JF, Howell RM, Srivastava DK, Robison LL, Hudson MM, Armstrong GT. Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Cancer 2021; 127:4646-4655. [PMID: 34411296 DOI: 10.1002/cncr.33860] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/03/2021] [Accepted: 06/25/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Limited data exist regarding left ventricular remodeling patterns observed in adult survivors of childhood cancer after therapy. METHODS Among 1190 adult survivors diagnosed with childhood cancer (median age at diagnosis, 9 years [interquartile range (IQR), 3.8-14.4 years]; age at evaluation, 35.6 years [IQR, 29.5-42.8 years]), treatment exposures included anthracyclines (n = 346), chest radiotherapy (n = 174), both (n = 245), or neither (n = 425). Prospective echocardiographic assessment compared survivors with 449 noncancer controls classified according to left ventricle geometric patterns. Associations between left ventricle geometric patterns and decreased exercise tolerance were assessed. RESULTS Overall, 28.2% of survivors (95% confidence interval [CI], 25.6%-30.8%) exhibited concentric remodeling, 2.4% (95% CI, 1.6%-3.5%) exhibited eccentric hypertrophy, and 1.1% (95% CI, 0.6%-1.9%) exhibited concentric hypertrophy. A greater proportion of survivors who received only chest radiotherapy (41%) had concentric remodeling compared with those who received only anthracyclines (24%), both (27%), or neither (27%; all P < .001), and all were greater than the proportions in noncancer controls (18%; all P < .05). Concentric remodeling was associated with radiation exposure, but not with anthracycline exposure, in multivariable models. Survivors who had concentric remodeling were more likely to have a maximal oxygen uptake peak <85% compared with those who had normal geometry (81.0% vs 66.3%; odds ratio, 1.75; 95% CI, 1.15-2.68). CONCLUSIONS Chest radiation therapy, but not anthracycline therapy, increased the risk for concentric remodeling in survivors of childhood cancer. The presence of concentric remodeling was associated with increased exercise intolerance.
Collapse
Affiliation(s)
- John L Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Carrie R Howell
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Juan C Plana
- Division of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhenghong Li
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Vijaya M Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel M Green
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeffrey A Towbin
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hugo R Martinez
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jason F Goldberg
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rebecca M Howell
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deo Kumar Srivastava
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
10
|
Rossi L, Cambraia Lopes P, Marques Leitão J, Janus C, van de Pol M, Breedveld S, Penninkhof J, Heijmen BJM. On the Importance of Individualized, Non-Coplanar Beam Configurations in Mediastinal Lymphoma Radiotherapy, Optimized With Automated Planning. Front Oncol 2021; 11:619929. [PMID: 33937025 PMCID: PMC8082440 DOI: 10.3389/fonc.2021.619929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Literature is non-conclusive regarding selection of beam configurations in radiotherapy for mediastinal lymphoma (ML) radiotherapy, and published studies are based on manual planning with its inherent limitations. In this study, coplanar and non-coplanar beam configurations were systematically compared, using a large number of automatically generated plans. Material and Methods An autoplanning workflow, including beam configuration optimization, was configured for young female ML patients. For each of 25 patients, 24 plans with different beam configurations were generated with autoplanning: 11 coplanar CP_x plans and 11 non-coplanar NCP_x plans with x = 5 to 15 IMRT beams with computer-optimized, patient-specific configurations, and the coplanar VMAT and non-coplanar Butterfly VMAT (B-VMAT) beam angle class solutions (600 plans in total). Results Autoplans compared favorably with manually generated, clinically delivered plans, ensuring that beam configuration comparisons were performed with high quality plans. There was no beam configuration approach that was best for all patients and all plan parameters. Overall there was a clear tendency towards higher plan quality with non-coplanar configurations (NCP_x≥12 and B-VMAT). NCP_x≥12 produced highly conformal plans with on average reduced high doses in lungs and patient and also a reduced heart Dmean, while B-VMAT resulted in reduced low-dose spread in lungs and left breast. Conclusions Non-coplanar beam configurations were favorable for young female mediastinal lymphoma patients, with patient-specific and plan-parameter-dependent dosimetric advantages of NCP_x≥12 and B-VMAT. Individualization of beam configuration approach, considering also the faster delivery of B-VMAT vs. NCP_x≥12, can importantly improve the treatments.
Collapse
Affiliation(s)
- Linda Rossi
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Cecile Janus
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Marjan van de Pol
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Joan Penninkhof
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Ben J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| |
Collapse
|
11
|
Hoskin P, Popova B, Schofield O, Brammer C, Robinson M, Brunt AM, Madhavan K, Illidge T, Gallop-Evans E, Syndikus I, Clifton-Hadley L, Kirkwood AA. 4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT): long-term follow-up of a multicentre, randomised, phase 3, non-inferiority trial. Lancet Oncol 2021; 22:332-340. [PMID: 33539729 DOI: 10.1016/s1470-2045(20)30686-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal radiotherapy dose for indolent non-Hodgkin lymphoma is uncertain. We aimed to compare 24 Gy in 12 fractions (representing the standard of care) with 4 Gy in two fractions (low-dose radiation). METHODS FoRT (Follicular Radiotherapy Trial) is a randomised, multicentre, phase 3, non-inferiority trial at 43 study centres in the UK. We enrolled patients (aged >18 years) with indolent non-Hodgkin lymphoma who had histological confirmation of follicular lymphoma or marginal zone lymphoma requiring radical or palliative radiotherapy. No limit on performance status was stipulated, and previous chemotherapy or radiotherapy to another site was permitted. Radiotherapy target sites were randomly allocated (1:1) either 24 Gy in 12 fractions or 4 Gy in two fractions using minimisation and stratified by histology, treatment intent, and study centre. Randomisation was centralised through the Cancer Research UK and University College London Cancer Trials Centre. Patients, treating clinicians, and investigators were not masked to random assignments. The primary endpoint was time to local progression in the irradiated volume based on clinical and radiological evaluation and analysed on an intention-to-treat basis. The non-inferiority threshold aimed to exclude the chance that 4 Gy was more than 10% inferior to 24 Gy in terms of local control at 2 years (HR 1·37). Safety (in terms of adverse events) was analysed in patients who received any radiotherapy and who returned an adverse event form. FoRT is registered with ClinicalTrials.gov, NCT00310167, and the ISRCTN Registry, ISRCTN65687530, and this report represents the long-term follow-up. FINDINGS Between April 7, 2006, and June 8, 2011, 614 target sites in 548 patients were randomly assigned either 24 Gy in 12 fractions (n=299) or 4 Gy in two fractions (n=315). At a median follow-up of 73·8 months (IQR 61·9-88·0), 117 local progression events were recorded, 27 in the 24 Gy group and 90 in the 4 Gy group. The 2-year local progression-free rate was 94·1% (95% CI 90·6-96·4) after 24 Gy and 79·8% (74·8-83·9) after 4 Gy; corresponding rates at 5 years were 89·9% (85·5-93·1) after 24 Gy and 70·4% (64·7-75·4) after 4 Gy (hazard ratio 3·46, 95% CI 2·25-5·33; p<0·0001). The difference at 2 years remains outside the non-inferiority margin of 10% at -13·0% (95% CI -21·7 to -6·9). The most common events at week 12 were alopecia (19 [7%] of 287 sites with 24 Gy vs six [2%] of 301 sites with 4 Gy), dry mouth (11 [4%] vs five [2%]), fatigue (seven [2%] vs five [2%]), mucositis (seven [2%] vs three [1%]), and pain (seven [2%] vs two [1%]). No treatment-related deaths were reported. INTERPRETATION Our findings at 5 years show that the optimal radiotherapy dose for indolent lymphoma is 24 Gy in 12 fractions when durable local control is the aim of treatment. FUNDING Cancer Research UK.
Collapse
Affiliation(s)
- Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
| | - Biliana Popova
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Oliver Schofield
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | | | - A Murray Brunt
- University Hospitals of North Midland & Keele University, Stoke-on-Trent, UK
| | | | - Tim Illidge
- National Institute of Health Research Biomedical Research Centre, University of Manchester, Christie Hospital, Manchester, UK
| | | | | | - Laura Clifton-Hadley
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Amy A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| |
Collapse
|
12
|
Wirth A, Mikhaeel NG, Aleman BM, Pinnix CC, Constine LS, Ricardi U, Illidge TM, Eich HT, Hoppe BS, Dabaja B, Ng AK, Kirova Y, Berthelsen AK, Dieckmann K, Yahalom J, Specht L. Involved Site Radiation Therapy in Adult Lymphomas: An Overview of International Lymphoma Radiation Oncology Group Guidelines. Int J Radiat Oncol Biol Phys 2020; 107:909-933. [DOI: 10.1016/j.ijrobp.2020.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
|
13
|
Hoppe RT, Advani RH, Ai WZ, Ambinder RF, Armand P, Bello CM, Benitez CM, Bierman PJ, Boughan KM, Dabaja B, Gordon LI, Hernandez-Ilizaliturri FJ, Herrera AF, Hochberg EP, Huang J, Johnston PB, Kaminski MS, Kenkre VP, Khan N, Lynch RC, Maddocks K, McConathy J, McKinney M, Metzger M, Morgan D, Mulroney C, Rabinovitch R, Rosenspire KC, Seropian S, Tao R, Winter JN, Yahalom J, Burns JL, Ogba N. Hodgkin Lymphoma, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:755-781. [PMID: 32502987 DOI: 10.6004/jnccn.2020.0026] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The NCCN Clinical Practice Guidelines in Oncology for Hodgkin Lymphoma (HL) provide recommendations for the management of adult patients with HL. The NCCN panel meets at least annually to review comments from reviewers within their institutions, examine relevant data, and reevaluate and update their recommendations. Current management of classic HL involves initial treatment with chemotherapy alone or combined modality therapy followed by restaging with PET/CT to assess treatment response. Overall, the introduction of less toxic and more effective regimens has significantly advanced HL cure rates. This portion of the NCCN Guidelines focuses on the management of classic HL.
Collapse
Affiliation(s)
| | | | - Weiyun Z Ai
- 2UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | - Kirsten M Boughan
- 7Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Leo I Gordon
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Jiayi Huang
- 13Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Ryan C Lynch
- 18Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Kami Maddocks
- 19The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Monika Metzger
- 22St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Randa Tao
- 28Huntsman Cancer Institute at the University of Utah
| | - Jane N Winter
- 9Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | |
Collapse
|
14
|
Samuel R, Thomas E, Gilson D, Prestwich R. Quality Assurance Peer Review for Radiotherapy for Haematological Malignancies. Clin Oncol (R Coll Radiol) 2019; 31:e1-e8. [DOI: 10.1016/j.clon.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 01/28/2023]
|
15
|
New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer. Nat Rev Urol 2019; 16:523-538. [DOI: 10.1038/s41585-019-0213-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
|
16
|
Urwin R, Barrington SF, Mikhaeel NG. Role of PET imaging in adaptive radiotherapy for lymphoma. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:411-419. [DOI: 10.23736/s1824-4785.18.03089-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
17
|
Prestwich R, Patel C, Scarsbrook A, Cosgrove V, Thomas E, Gilson D, Bird D. Axillary radiotherapy for nodal lymphoma: What CTV expansion is required to account for absence of pre-chemotherapy treatment position FDG PET-CT? Clin Transl Radiat Oncol 2018; 13:14-18. [PMID: 30246160 PMCID: PMC6146559 DOI: 10.1016/j.ctro.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Involved site lymphoma radiotherapy clinical target volumes (CTV) require expansion in the absence of treatment-position pre-chemotherapy PET-CT. This prospective imaging study evaluates CTV contouring for axillary lymphoma using diagnostic imaging compared with co-registered treatment-position PET-CT. Generous expansion axially and cranio-caudally is required to encompass pre-chemotherapy disease without treatment-position pre-chemotherapy PET-CT.
Collapse
Affiliation(s)
- Robin Prestwich
- Clinical Oncology, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| | - Chirag Patel
- Radiology and Nuclear Medicine, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| | - Andrew Scarsbrook
- Radiology and Nuclear Medicine, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| | - Viv Cosgrove
- Medical Physics and Engineering, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| | - Emma Thomas
- Clinical Oncology, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| | - Di Gilson
- Clinical Oncology, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| | - David Bird
- Medical Physics and Engineering, Bexley Wing, St. James's University Hospital, Leeds Teaching Hospitals Trust, Leeds LS9 7TF, England, UK
| |
Collapse
|
18
|
Peignaux K, Gonzague-Casabianca L. Radiothérapie « involved node » et « involved site » des lymphomes hodgkiniens : quels volumes cible ? Cancer Radiother 2018; 22:401-403. [DOI: 10.1016/j.canrad.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
|
19
|
A comparison of selected dosimetric parameters of two Hodgkin Lymphoma radiotherapy techniques with reference to potential risk of radiation induced heart disease. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2018. [DOI: 10.2478/pjmpe-2018-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Purpose: Hodgkin lymphoma (HL) is one of the most frequent malignancies among pediatric patients. One of the common causes of death in HL survivors after radiation therapy (RT), is radiation-induced heart disease (RIHD). The aim of this study was to compare several dosimetric parameters for two methods of early stage Hodgkin lymphoma radiotherapy with reference to potential risk of RIHD.
Materials and Methods: Using a series of computed tomography slices of 40 young patients, treatment planning was done in two methods of HL RT, including involved field (IFRT) and involved site (ISRT) in doses of 20, 30, and 35 Gy. Contouring of clinical target volume as well as the organs at risk, including the heart, was performed by a radiation oncologist. The mean and maximum dose of heart (Dheart-mean and Dheart-max), the volume of heart receiving a dose more than 25 Gy (V25), and the standard deviation of dose as a dose homogeneity index in heart, were used to compare the RIHD risk.
Results: The mean value for Dheart-mean in ISRT method in all doses was less compare to IFRT. Maximum reduction in mean value of Dheart-mean occurred at moving from 30 Gy IFRT to ISRT by 9.53 Gy (p < 0.001) and minimum was between 35 Gy IFRT and ISRT. The mean value for Dheart-max was fewer in IFRT rather than ISRT and the maximum difference was between 35 Gy IFRT and ISRT (1.35 Gy). The mean of V25 of heart was 26.66% and 23.74% in 35 Gy IFRT and ISRT, respectively, and dose distribution was more homogeneous in IFRT.
Conclusions: If Dheart-max and V25 of heart or homogeneity of dose distribution in heart are considered as determining factors in RIHD, then IFRT can be considered optimum, especially in 35 Gy IFRT; while, assuming the Dheart-mean as the most important factor in RIHD, superiority of ISRT over IFRT is observed.
Collapse
|
20
|
Taylor C, McGale P, Brønnum D, Correa C, Cutter D, Duane FK, Gigante B, Jensen MB, Lorenzen E, Rahimi K, Wang Z, Darby SC, Hall P, Ewertz M. Cardiac Structure Injury After Radiotherapy for Breast Cancer: Cross-Sectional Study With Individual Patient Data. J Clin Oncol 2018; 36:2288-2296. [PMID: 29791285 PMCID: PMC6067799 DOI: 10.1200/jco.2017.77.6351] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Incidental cardiac irradiation can cause cardiac injury, but little is known about the effect of radiation on specific cardiac segments. Methods For 456 women who received breast cancer radiotherapy between 1958 and 2001 and then later experienced a major coronary event, information was obtained on the radiotherapy regimen they received and on the location of their cardiac injury. For 414 women, all with documented location of left ventricular (LV) injury, doses to five LV segments were estimated. For 133 women, all with documented location of coronary artery disease with ≥ 70% stenosis, doses to six coronary artery segments were estimated. For each segment, numbers of women with left-sided and right-sided breast cancer were compared. Results Of women with LV injury, 243 had left-sided breast cancer and 171 had right-sided breast cancer (ratio of left v right, 1.42; 95% CI, 1.17 to 1.73), reflecting the higher typical LV radiation doses in left-sided cancer (average dose left-sided, 8.3 Gy; average dose right-sided, 0.6 Gy; left minus right dose difference, 7.7 Gy). For individual LV segments, the ratios of women with left- versus right-sided radiotherapy were as follows: inferior, 0.94 (95% CI, 0.70 to 1.25); lateral, 1.42 (95% CI, 1.04 to 1.95); septal, 2.09 (95% CI, 1.37 to 3.19); anterior, 1.85 (95% CI, 1.39 to 2.46); and apex, 4.64 (95% CI, 2.42 to 8.90); corresponding left-minus-right dose differences for these segments were 2.7, 4.9, 7.2, 10.4, and 21.6 Gy, respectively ( Ptrend < .001). For women with coronary artery disease, the ratios of women with left- versus right-radiotherapy for individual coronary artery segments were as follows: right coronary artery proximal, 0.48 (95% CI, 0.26 to 0.91); right coronary artery mid or distal, 1.69 (95% CI, 0.85 to 3.36); circumflex proximal, 1.46 (95% CI, 0.72 to 2.96); circumflex distal, 1.11 (95% CI, 0.45 to 2.73); left anterior descending proximal, 1.89 (95% CI, 1.07 to 3.34); and left anterior descending mid or distal, 2.33 (95% CI, 1.19 to 4.59); corresponding left-minus-right dose differences for these segements were -5.0, -2.5, 1.6, 3.5, 9.5, and 38.8 Gy ( Ptrend = .002). Conclusion For individual LV and coronary artery segments, higher radiation doses were strongly associated with more frequent injury, suggesting that all segments are sensitive to radiation and that doses to all segments should be minimized.
Collapse
Affiliation(s)
- Carolyn Taylor
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Paul McGale
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Dorthe Brønnum
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Candace Correa
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - David Cutter
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Frances K. Duane
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Maj-Britt Jensen
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Ebbe Lorenzen
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Kazem Rahimi
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Zhe Wang
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Sarah C. Darby
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Per Hall
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| | - Marianne Ewertz
- Carolyn Taylor, Paul McGale, David Cutter, Frances K. Duane, Zhe Wang, and Sarah C. Darby, Nuffield Department of Population Health, University of Oxford; Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford, United Kingdom; Dorthe Brønnum, North Denmark Regional Hospital, Hjoerring; Maj-Britt Jensen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen; Ebbe Lorenzen and Marianne Ewertz, Odense University Hospital, Odense, Denmark; Candace Correa, Community Cancer Center, Normal, IL; Bruna Gigante and Per Hall, Karolinska Institutet; Bruna Gigante, Danderyd Hospital; and Per Hall, South General Hospital, Stockholm, Sweden
| |
Collapse
|
21
|
Nowosinska E, Chan PS, Buscombe JR. Use of 18F FDG PET and the short temporal response of Hodgkin's disease to RIT. World J Nucl Med 2018; 17:171-177. [PMID: 30034281 PMCID: PMC6034536 DOI: 10.4103/wjnm.wjnm_50_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Radioimmunotherapy (RIT) has been available for some time to treat patients with non-Hodgkin's lymphoma, but its use in Hodgkin's lymphoma has been less available, partly because of the need to find an appropriate antibody. A new radioiodinated chimeric antibody directed against the CD25 epitope (131I basiliximab) seems promising, but assessment of response has been difficult. 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) has become a standard method by which the response of Hodgkin's disease to chemotherapy is both predicted and assessed with well-understood criteria of response. The aim of this study is to determine 18F-FDG-PET can be used to assess response to RIT. Pre- and post-treatment 18F-FDG-PET imaging was performed in a series of 13 patients with advanced Hodgkin's disease who had failed conventional therapy and had been enrolled on a compassionate use program for treatment with 131I basiliximab. The 131I basiliximab was given at an activity of 1200MBq/m2 with one patient receiving 2 cycles and the rest a single cycle. The 18F-FDG-PET studies were compared using the “Deauville” criteria and by comparing the maximum standardized uptake value (SUVmax) of target tumors before and 4 and 8 weeks after treatment. All patients survived long enough for their initial 18F-FDG-PET-computed tomography scan at 4 weeks after their 131I basiliximab therapy. One out of ten patients with “Deauville” Grade 4 or 5 response died during the 6-month follow-up period. Two out of three patients with a “Deauville” Grade 2 or 3 response died in the follow-up period. The mean SUVmax pretreatment was 11.9 (±4.7); at 4-week posttreatment, the mean SUVmax was significantly lower at 6.5 (±5.8) (P = 0.02). At 8 weeks, the mean SUVmax was 8.8 (±7.0), which was not significantly different from the pretreatment level. 18F-FDG-PET imaging is able to predict the short-term response to treatment of Hodgkin's disease by RIT, and an initial poor response appears to predict poor outcome. Early changes in 18F-FDG-PET uptake did not predict sustained response and by 8 weeks all but one patient had recurrent disease.
Collapse
Affiliation(s)
- Ewa Nowosinska
- Department of Nuclear Medicine, St Bartholomew's Hospital, London EC1A 7BE, England
| | - Pei San Chan
- Department of Nuclear Medicine, Royal Free Hospital, London NW3 2QG, England
| | - John R Buscombe
- Department of Nuclear Medicine, Addenbrookes Hospital, Cambridge CB2 0QQ, England
| |
Collapse
|
22
|
Dracham CB, Shankar A, Madan R. Radiation induced secondary malignancies: a review article. Radiat Oncol J 2018; 36:85-94. [PMID: 29983028 PMCID: PMC6074073 DOI: 10.3857/roj.2018.00290] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022] Open
Abstract
Radiation-induced second malignancies (RISM) is one of the important late side effects of radiation therapy and has an impact on optimal treatment decision-making. Many factors contribute to the development of RISM such as age at radiation, dose and volume of irradiated area, type of irradiated organ and tissue, radiation technique and individual and family history of cancer. Exact mechanism of RISM is unknown. But nowadays, it is a growing concern in oncology because of the increased number of cancer survivors and efforts are being made to prevent or decrease the incidence of RISM. The primary search for articles was carried via Google Scholar and PubMed with keywords included 'radiation induced malignancies, second malignancies, and chemotherapy induced malignancies'. Additional papers were found through references from relevant articles. In this review article, we have discussed about the pathogenesis, factors contributing to RISM, screening and prevention strategies of RISM.
Collapse
Affiliation(s)
| | - Abhash Shankar
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| |
Collapse
|
23
|
Tavakoli MB, Maleki M, Akhavan A, Hadisinia T, Abedi I, Amouheidari A. Comparison and Evaluation of Different Treatment Plans with IFRT Field and 6 and 18 MV Energies in Hodgkin's Lymphoma Involvement Neck and Mediastinum. J Biomed Phys Eng 2018; 8:65-72. [PMID: 29732341 PMCID: PMC5928312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/18/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Radiotherapy with large mantle field is an effective technique in increasing the risk of secondary cancers among HL (Hodgkin Lymphoma) patients; therefore, it is essential to choose an effective treatment field including the least medical conditions in radiotherapy. OBJECTIVE The present study aimed to plan separate fields for neck and mediastinum using various energies, to compare dose distribution with MLC and to block field formation. MATERIALS AND METHODS In this study, 3D conformal treatments, Siemens Oncor accelerator equipped with multi-leaf collimator (MLC) were performed to create anterior-posterior fields. CT-scan data of 18 female patients with neck and mediastinal involvement was imported in TIGRT treatment planning system, and then treatment plans were introduced. RESULTS AND CONCLUSION Using treatment plan 1, photon 6 MV in neck weighting 1 from interior, 0.5 from posterior, photon 18MV in mediastinum weighting 1 from interior and 0.5 from posterior, it was shown that regarding the common treatment plan used with photon 6 MV, mean dose delivered to breast, lung, esophagus and larynx reduced 6, 7, 41 and 10 percent, respectively and uniformity index improved by 10 percent. Using block compared to MLC in all treatment plans offered improved average dose in all organs under study. To protect breast and lung while using MLC and block in the first treatment plan seemed to be more appropriate; however, using blocks in comparison to MLC increased delivered mean dose in all organs under study. Using separate fields with Pb blocks, though, showed smaller increase.
Collapse
Affiliation(s)
- M B Tavakoli
- Professor, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Maleki
- M.Sc., Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Akhavan
- Assistant Professor, Department of Radiation-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - T Hadisinia
- Ph.D. Student, Department of Medical Physics and Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - I Abedi
- Ph.D. Student, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Amouheidari
- Oncologist, Department of Radiation Oncology, Isfahan Milad Hospital, Isfahan, Iran
| |
Collapse
|
24
|
Hammersen F, Lewin P, Gebauer J, Kreitschmann-Andermahr I, Brabant G, Katalinic A, Waldmann A. Sleep quality and health-related quality of life among long-term survivors of (non-) Hodgkin lymphoma in Germany. PLoS One 2017; 12:e0187673. [PMID: 29107959 PMCID: PMC5673196 DOI: 10.1371/journal.pone.0187673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
This study investigated sleep quality and health-related quality of life (HRQOL) among long-term survivors of Hodgkin (HL) and non-Hodgkin lymphoma (NHL). The aim was to explore the impact of personal and health-related factors on sleep quality as well as associations between sleep quality and HRQOL. For the postal survey, participants with a minimum age of 18 years initially treated between 1998 and 2008 were recruited via the population-based cancer registry in Schleswig-Holstein, Northern Germany. Questionnaires included amongst others the Pittsburg Sleep Quality Index (PSQI) and the 36-Item Short Form Health Survey (SF-36v1). Descriptive and comparative statistics were performed. Additionally, a regression analysis was conducted to identify predictors of sleep quality. In total, we recruited 515 participants (398 NHL, 117 HL) with a mean age of 63.1 years. Approximately half of the survivors were classified as good sleepers. HRQOL scores differed between good and poor sleepers with lower scores in poor sleepers. In a prediction model, self-reported depression, exhaustion, higher age, inability to work, endocrinological disorders and female gender classified as predictors of sleep quality. This study highlights the impact of sleep quality on HRQOL in long-term survivors of NHL and HL. Thus, sleep quality should be routinely assessed during follow-up of cancer survivors with special attention to patients with potential risk factors.
Collapse
Affiliation(s)
- Friederike Hammersen
- Institute for Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
- * E-mail:
| | - Philip Lewin
- Institute for Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
| | - Judith Gebauer
- Experimental and Clinical Endocrinology Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - Georg Brabant
- Experimental and Clinical Endocrinology Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
- Institute for Cancer Epidemiology e.V., University of Luebeck, Luebeck, Germany
| | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Luebeck, Luebeck, Germany
- Hamburg Cancer Registry, Hamburg, Germany
| |
Collapse
|
25
|
Bates JE, Dhakal S, Mazloom A, Casulo C, Constine LS. Benefit from the inclusion of radiation therapy in the treatment of patients with stage III classical Hodgkin lymphoma: A propensity matched analysis of the Surveillance, Epidemiology, and End Results database. Radiother Oncol 2017; 124:325-330. [PMID: 28778348 DOI: 10.1016/j.radonc.2017.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND While stage III and IV classical Hodgkin lymphoma (HL) patients are often combined and defined as "advanced stage," there are significant differences in disease distribution and burden between the two stages. This may obscure advantages of radiotherapy (RT) in a combined modality therapy strategy in stage III disease due to the relative lack of benefit in stage IV patients. METHODS We queried the Surveillance, Epidemiology, and End Results (SEER) database, restricting our search to patients with stage III classical HL diagnosed from 2004 to 2012, to examine the difference in overall and cause-specific survival (OS and CSS) between patients who did or did not receive RT. RESULTS Patients treated with RT had improved OS and CSS relative to those treated without RT (5-year OS 91.6% with RT compared to 71.4% without RT, HR=0.34, p<0.001) and CSS (5-year OS 95.4% with RT compared to 84.7% without RT, HR=0.32, p<0.001). A benefit in OS and/or CSS was seen in all patient subgroups except for older adults (>64years). CONCLUSION These data support at least a cautionary approach to omitting RT from treatment strategies for patients with advanced stage HL.
Collapse
Affiliation(s)
- James E Bates
- Department of Radiation Oncology, University of Florida, Gainesville, USA
| | - Sughosh Dhakal
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Ali Mazloom
- Tacoma Valley Radiation Oncology Center, USA
| | - Carla Casulo
- Department of Medicine, Division of Medical Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Louis S Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, USA.
| |
Collapse
|
26
|
Patterns of failure of diffuse large B‑cell lymphoma patients after involved-site radiotherapy. Strahlenther Onkol 2017; 193:1014-1023. [DOI: 10.1007/s00066-017-1186-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
|
27
|
Bird D, Patel C, Scarsbrook AF, Cosgrove V, Thomas E, Gilson D, Prestwich RJ. Evaluation of clinical target volume expansion required for involved site neck radiotherapy for lymphoma to account for the absence of a pre-chemotherapy PET-CT in the radiotherapy treatment position. Radiother Oncol 2017; 124:161-167. [DOI: 10.1016/j.radonc.2017.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/02/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
|
28
|
Second cancer risk assessments after involved-site radiotherapy for mediastinal Hodgkin lymphoma. Med Phys 2017; 44:3866-3874. [DOI: 10.1002/mp.12327] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 05/01/2017] [Indexed: 12/19/2022] Open
|
29
|
|
30
|
Zimmermann M, Oehler C, Mey U, Ghadjar P, Zwahlen DR. Radiotherapy for Non-Hodgkin's lymphoma: still standard practice and not an outdated treatment option. Radiat Oncol 2016; 11:110. [PMID: 27577712 PMCID: PMC5004297 DOI: 10.1186/s13014-016-0690-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/23/2016] [Indexed: 02/01/2023] Open
Abstract
Two large, recently published observational studies demonstate a clear down-trend in the use of radiotherapy (RT) over the last 15 years, both in the setting of follicular and diffuse large B-cell lymphoma. This change of practice might have a negative impact on clinical outcome. Even within the context of modern systemic therapy, omission of RT translates not only into a shorter progression-free survival (PFS), but also into a worse overall survival (OS). RT should therefore remain standard practice. This short review is aiming to summarize current guidelines and the best evidence available in the management of non-Hodgkin’s lymphoma. Potentially practice changing, ongoing trials will be highlighted.
Collapse
Affiliation(s)
- Michel Zimmermann
- Department of Radiation Oncology, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Christoph Oehler
- Department of Radiation Oncology, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland
| | - Ulrich Mey
- Department of Medical Oncology and Haematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Kantonsspital Graubünden, Loëstrasse 170, 7000, Chur, Switzerland.
| |
Collapse
|
31
|
Hodgkin Lymphoma: the Changing Role of Radiation Therapy in Early-Stage Disease—the Role of Functional Imaging. Curr Treat Options Oncol 2016; 16:45. [PMID: 26187795 DOI: 10.1007/s11864-015-0360-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Early-stage classical Hodgkin lymphoma (CHL) is a highly curable malignancy. Historically, extended-field radiotherapy (EFRT) alone showed excellent cure rates, but the risk of radiotherapy (RT)-associated toxicities led to combined modality therapy (CMT) replacing RT alone. RT has subsequently evolved further with significant reductions of dose and field size, and is currently restricted to involved sites only (ISRT). Contemporary CMT yields cure rates in excess of 85%, and most studies do not have adequate follow-up required to evaluate the risk reduction in late effects. In an effort to avoid RT altogether, response-adapted treatment approaches utilizing results of interim [(18)F]fluorodeoxyglucose (FDG) positron emission tomography with fused computed tomography (PET/CT) imaging have been studied. Results from two studies in favorable-risk (UK RAPID and EORTC H10F) and one in unfavorable-risk patients (EORTC H10U) suggest that omission of RT in patients with a negative interim PET/CT response (Deauville score ≤2) yields slightly inferior progression-free survival (PFS) compared to conventional CMT, but with no difference in overall survival (OS) albeit with short-term follow-up. In order to extrapolate results to daily practice, it is critical to understand the selection of patients entered on trials since definitions of favorable and unfavorable disease vary between study groups. Currently, CMT continues to be the standard of care for the vast majority of patients with early-stage CHL and RT is an integral part of therapy in patients with bulky disease. However, for selected patients with favorable characteristics, emerging data suggest that a chemotherapy-alone approach is reasonable.
Collapse
|
32
|
Abstract
The management of diffuse large B-cell lymphoma depends on the initial diagnosis including molecular and immunophenotypic characteristics, Ann Arbor staging, and International Prognostic Index (IPI score). Treatment approaches with different chemotherapy regimens used is discussed in detail. The role of radiation as a consolidation is discussed including: (1) the prerituximab randomized trials that challenged the role of radiation, (2) recent prospective studies (UNFOLDER/RICOVER-60), and (3) retrospective studies; the last 2 showed a potential benefit of radiation both for early and advanced stage. The document also discusses the role of positron emission tomography/computed tomography for predicting outcome and potentially guiding therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Collapse
|
33
|
Hoskin P, Díez P, Gallop-Evans E, Syndikus I, Bates A, Bayne M. Recommendations for Radiotherapy Technique and Dose in Extra-nodal Lymphoma. Clin Oncol (R Coll Radiol) 2016; 28:62-8. [DOI: 10.1016/j.clon.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/07/2015] [Accepted: 09/10/2015] [Indexed: 01/08/2023]
|
34
|
McKay P, Fielding P, Gallop-Evans E, Hall GW, Lambert J, Leach M, Marafioti T, McNamara C. Guidelines for the investigation and management of nodular lymphocyte predominant Hodgkin lymphoma. Br J Haematol 2015; 172:32-43. [PMID: 26538004 DOI: 10.1111/bjh.13842] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Pamela McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Gartnavel Hospital; Glasgow UK
| | - Patrick Fielding
- PETIC; Department of Radiology; University Hospital of Wales; Cardiff UK
| | - Eve Gallop-Evans
- Department of Clinical Oncology; Velindre Cancer Centre; Cardiff UK
| | - Georgina W. Hall
- Paediatric Haematology/Oncology Unit; Children's Hospital; John Radcliffe Hospital; Headington Oxford
| | - Jonathan Lambert
- Department of Haematology; University College London Hospitals; London UK
| | - Mike Leach
- Department of Haematology; Beatson West of Scotland Cancer Centre; Gartnavel Hospital; Glasgow UK
| | - Teresa Marafioti
- Department of Pathology; University College London Hospitals; London UK
| | | | | |
Collapse
|
35
|
Simpson WL, Lee KM, Sosa N, Cooper N, Scigliano E, Brody JD, Doucette JT, Kostakoglu L. Lymph nodes can accurately be measured on PET-CT for lymphoma staging/restaging without a concomitant contrast enhanced CT scan. Leuk Lymphoma 2015; 57:1083-93. [PMID: 26422408 DOI: 10.3109/10428194.2015.1089437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Dual imaging with both contrast enhanced CT scan and PET-CT is recommended for evaluation of lymphoma. We compared the performance in identification and size measurements of involved lymph nodes in FDG-avid lymphomas on the low dose non-contrast enhanced CT of a PET-CT scan with those on a diagnostic contrast enhanced CT scan. The size of FDG-avid lymph nodes was measured in both the short and long axis on both the low dose non-contrast CT of the PET-CT and the contrast enhanced CT by two independent readers. A total of 307 FGD avid lymph nodes were identified in 52 patients. There was no statistically significant differences in the measured size of the nodes on the non-contrast and contrast enhanced scans (p=0.21). Baseline staging and restaging of FDG-avid lymphomas can be performed with one test, PET-CT, without an accompanying contrast enhanced CT scan, with no effect on the measured nodal size.
Collapse
Affiliation(s)
- William L Simpson
- a Department of Radiology , Body Imaging Section, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Karen M Lee
- a Department of Radiology , Body Imaging Section, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Ninoska Sosa
- b Department of Radiology, Division of Nuclear Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA ;,c Department of Radiology , Hospital General Plaza de la Salud , Santo Domingo , Dominican Republic
| | - Nancy Cooper
- a Department of Radiology , Body Imaging Section, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Eileen Scigliano
- d Department of Medicine, Division of Hematology and Medical Oncology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Joshua D Brody
- d Department of Medicine, Division of Hematology and Medical Oncology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - John T Doucette
- e Department of Preventative Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Lale Kostakoglu
- b Department of Radiology, Division of Nuclear Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| |
Collapse
|
36
|
Eng T, Ha CS. Image-guided radiation therapy in lymphoma management. Radiat Oncol J 2015; 33:161-71. [PMID: 26484299 PMCID: PMC4607569 DOI: 10.3857/roj.2015.33.3.161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 12/17/2022] Open
Abstract
Image-guided radiation therapy (IGRT) is a process of incorporating imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), Positron emission tomography (PET), and ultrasound (US) during radiation therapy (RT) to improve treatment accuracy. It allows real-time or near real-time visualization of anatomical information to ensure that the target is in its position as planned. In addition, changes in tumor volume and location due to organ motion during treatment can be also compensated. IGRT has been gaining popularity and acceptance rapidly in RT over the past 10 years, and many published data have been reported on prostate, bladder, head and neck, and gastrointestinal cancers. However, the role of IGRT in lymphoma management is not well defined as there are only very limited published data currently available. The scope of this paper is to review the current use of IGRT in the management of lymphoma. The technical and clinical aspects of IGRT, lymphoma imaging studies, the current role of IGRT in lymphoma management and future directions will be discussed.
Collapse
Affiliation(s)
- Tony Eng
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX, USA
| | - Chul S. Ha
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, TX, USA
| |
Collapse
|
37
|
The concept and evolution of involved site radiation therapy for lymphoma. Int J Clin Oncol 2015; 20:849-54. [DOI: 10.1007/s10147-015-0863-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/14/2015] [Indexed: 01/22/2023]
|
38
|
Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks. Clin Oncol (R Coll Radiol) 2015; 27:401-10. [DOI: 10.1016/j.clon.2015.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/04/2015] [Accepted: 03/12/2015] [Indexed: 12/25/2022]
|
39
|
Illidge T. Balancing Risks in Developing a Personalised Approach to the Treatment of Early Hodgkin Lymphoma: Have We Got the Balance Right? Clin Oncol (R Coll Radiol) 2015; 27:454-6. [PMID: 26108883 DOI: 10.1016/j.clon.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 11/27/2022]
Affiliation(s)
- T Illidge
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester, UK.
| |
Collapse
|
40
|
Zaffino P, Ciardo D, Piperno G, Travaini LL, Comi S, Ferrari A, Alterio D, Jereczek-Fossa BA, Orecchia R, Baroni G, Spadea MF. Radiotherapy of Hodgkin and Non-Hodgkin Lymphoma. Technol Cancer Res Treat 2015; 15:355-64. [DOI: 10.1177/1533034615582290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 03/19/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose: To improve the contouring of clinical target volume for the radiotherapy of neck Hodgkin/non-Hodgkin lymphoma by localizing the prechemotherapy gross target volume onto the simulation computed tomography using [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. Material and Methods: The gross target volume delineated on prechemotherapy [18F]-fluorodeoxyglucose positron emission tomography/computed tomography images was warped onto simulation computed tomography using deformable image registration. Fifteen patients with neck Hodgkin/non-Hodgkin lymphoma were analyzed. Quality of image registration was measured by computing the Dice similarity coefficient on warped organs at risk. Five radiation oncologists visually scored the localization of automatic gross target volume, ranking it from 1 (wrong) to 5 (excellent). Deformable registration was compared to rigid registration by computing the overlap index between the automatic gross target volume and the planned clinical target volume and quantifying the V95 coverage. Results: The Dice similarity coefficient was 0.80 ± 0.07 (median ± quartiles). The physicians’ survey had a median score equal to 4 (good). By comparing the rigid versus deformable registration, the overlap index increased from a factor of about 4 and the V95 (percentage of volume receiving the 95% of the prescribed dose) went from 0.84 ± 0.38 to 0.99 ± 0.10 (median ± quartiles). Conclusion: This study demonstrates the impact of using deformable registration between prechemotherapy [18F]-fluorodeoxyglucose positron emission tomography/computed tomography and simulation computed tomography, in order to automatically localize the gross target volume for radiotherapy treatment of patients with Hodgkin/non-Hodgkin lymphoma.
Collapse
Affiliation(s)
- P. Zaffino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - D. Ciardo
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - G. Piperno
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - L. L. Travaini
- Nuclear Medicine Division, European Institute of Oncology, Milan, Italy
| | - S. Comi
- Medical Physics Unit, European Institute of Oncology, Milano, Italy
| | - A. Ferrari
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - D. Alterio
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - B. A. Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - R. Orecchia
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - G. Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy
- Bioengineering Unit, Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
| | - M. F. Spadea
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| |
Collapse
|
41
|
Ballas L. Modern radiotherapeutic strategies in the management of lymphoma. Future Oncol 2015; 11:1011-20. [DOI: 10.2217/fon.14.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The history of radiation therapy in the treatment of malignancies is closely linked to its use in Hodgkin lymphoma. It was less than a decade after the first publication on x-rays that radiotherapy was used in the treatment of a Hodgkin lymphoma. Over time, radiotherapy has evolved with newer technology and better understanding of radiobiology. During this same time frame, the treatment of Hodgkin and non-Hodgkin lymphomas has also seen great progress. This review will provide detail on modern radiotherapy techniques, indications for utilization, and modern radiation field sizes and doses.
Collapse
|
42
|
Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O'Doherty MJ, Hustinx R, Biggi A, Cheson BD. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 2015; 32:3048-58. [PMID: 25113771 DOI: 10.1200/jco.2013.53.5229] [Citation(s) in RCA: 1057] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Recent advances in imaging, use of prognostic indices, and molecular profiling techniques have the potential to improve disease characterization and outcomes in lymphoma. International trials are under way to test image-based response–adapted treatment guided by early interim positron emission tomography (PET)–computed tomography (CT). Progress in imaging is influencing trial design and affecting clinical practice. In particular, a five-point scale to grade response using PET-CT, which can be adapted to suit requirements for early- and late-response assessment with good interobserver agreement, is becoming widely used both in practice- and response-adapted trials. A workshop held at the 11th International Conference on Malignant Lymphomas (ICML) in 2011 concluded that revision to current staging and response criteria was timely. METHODS An imaging working group composed of representatives from major international cooperative groups was asked to review the literature, share knowledge about research in progress, and identify key areas for research pertaining to imaging and lymphoma. RESULTS A working paper was circulated for comment and presented at the Fourth International Workshop on PET in Lymphoma in Menton, France, and the 12th ICML in Lugano, Switzerland, to update the International Harmonisation Project guidance regarding PET. Recommendations were made to optimize the use of PET-CT in staging and response assessment of lymphoma, including qualitative and quantitative methods. CONCLUSION This article comprises the consensus reached to update guidance on the use of PET-CT for staging and response assessment for [18F]fluorodeoxyglucose-avid lymphomas in clinical practice and late-phase trials.
Collapse
|
43
|
Follows GA, Ardeshna KM, Barrington SF, Culligan DJ, Hoskin PJ, Linch D, Sadullah S, Williams MV, Wimperis JZ. Guidelines for the first line management of classical Hodgkin lymphoma. Br J Haematol 2014; 166:34-49. [PMID: 24712411 DOI: 10.1111/bjh.12878] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- George A Follows
- Department of Haematology, Addenbrookes Hospital, Cambridge University Teaching Hospitals, Cambridge, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Morton LM, Swerdlow AJ, Schaapveld M, Ramadan S, Hodgson DC, Radford J, van Leeuwen FE. Current knowledge and future research directions in treatment-related second primary malignancies. EJC Suppl 2014; 12:5-17. [PMID: 26217162 PMCID: PMC4250537 DOI: 10.1016/j.ejcsup.2014.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 01/13/2023] Open
Abstract
Currently, 17-19% of all new primary malignancies occur in survivors of cancer, causing substantial morbidity and mortality. Research has shown that cancer treatments are important contributors to second malignant neoplasm (SMN) risk. In this paper we summarise current knowledge with regard to treatment-related SMNs and provide recommendations for future research. We address the risks associated with radiotherapy and systemic treatments, modifying factors of treatment-related risks (genetic susceptibility, lifestyle) and the potential benefits of screening and interventions. Research priorities were identified during a workshop at the 2014 Cancer Survivorship Summit organised by the European Organisation for Research and Treatment of Cancer. Recently, both systemic cancer treatments and radiotherapy approaches have evolved rapidly, with the carcinogenic potential of new treatments being unknown. Also, little knowledge is available about modifying factors of treatment-associated risk, such as genetic variants and lifestyle. Therefore, large prospective studies with biobanking, high quality treatment data (radiation dose-volume, cumulative drug doses), and data on other cancer risk factors are needed. International collaboration will be essential to have adequate statistical power for such investigations. While screening for SMNs is included in several follow-up guidelines for cancer survivors, its effectiveness in this special population has not been demonstrated. Research into the pathogenesis, tumour characteristics and survival of SMNs is essential, as well as the development of interventions to reduce SMN-related morbidity and mortality. Prediction models for SMN risk are needed to inform initial treatment decisions, balancing chances of cure and SMNs and to identify high-risk subgroups of survivors eligible for screening.
Collapse
Affiliation(s)
- Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Anthony J. Swerdlow
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, United Kingdom
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Safaa Ramadan
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - David C. Hodgson
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - John Radford
- The University of Manchester and The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Flora E. van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
45
|
Meijer HJM, Debats OA, Th van Lin ENJ, van Vulpen M, Witjes JA, Oyen WJG, Barentsz JO, Kaanders JHAM. Individualized image-based lymph node irradiation for prostate cancer. Nat Rev Urol 2013; 10:376-85. [PMID: 23712209 DOI: 10.1038/nrurol.2013.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Controversy surrounds the benefit of whole pelvis radiotherapy (WPRT) over prostate-only radiotherapy (PORT) for intermediate-risk and high-risk patients with prostate cancer. In the PSA screening era, two large randomized trials as well as multiple retrospective studies comparing WPRT with PORT have been performed, albeit with contradictory results. Data regarding the use of WPRT in patients with biochemical recurrence after prostatectomy are scarce. As a consequence, the practice of WPRT varies worldwide. Advanced highly accurate imaging methods for the detection of lymph node metastases in patients with prostate cancer have been developed, such as PET, single photon emission computed tomography (SPECT), diffusion-weighted MRI and magnetic resonance lymphography (MRL). The use of these new imaging methods might improve nodal irradiation, as they can be used not only for selection of patients, but also for accurately determining the target volume to reduce geographical miss. Furthermore, these new techniques can enable dose escalation to involved lymph nodes.
Collapse
Affiliation(s)
- Hanneke J M Meijer
- Department of Radiation Oncology [875], Radboud University Nijmegen Medical Centre, P O Box 9101, 6500 HB Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Paisey SA, Bates AT, Johnson PWM. Is there a role for consolidation radiotherapy in Hodgkin’s lymphoma in the era of the PET scan? Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.12.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Treatment results of Hodgkin’s lymphoma have dramatically improved with the introduction of combined modality treatment with multiagent chemotherapy regimens and radiotherapy in the last half century. However, in the last decade, with the increasing efficacy of chemotherapy, the enthusiasm for radiotherapy has waned as a result of the late effects among survivors. Furthermore, risk-adapted treatment approaches using functional imaging as a prognostic tool have become the focus of recent trials. Here we discuss current evidence for the use of radiotherapy to improve local control, and how patients may be selected who will benefit.
Collapse
Affiliation(s)
- Sangeeta A Paisey
- Cancer Research UK Centre, University of Southampton, Somers Cancer Research Building, MP824, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Andrew T Bates
- Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Peter WM Johnson
- Cancer Research UK Centre, University of Southampton, Somers Cancer Research Building, MP824, Southampton General Hospital, Southampton, SO16 6YD, UK.
| |
Collapse
|