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Pediatric radiotherapy for thoracic and abdominal targets: organ motion, reported margin sizes, and delineation variations – a systematic review. Radiother Oncol 2022; 173:134-145. [DOI: 10.1016/j.radonc.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/21/2022]
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Manem VSK, Dhawan A. Modelling recurrence and second cancer risks induced by proton therapy. MATHEMATICAL MEDICINE AND BIOLOGY : A JOURNAL OF THE IMA 2018; 35:347-361. [PMID: 29106564 PMCID: PMC6132082 DOI: 10.1093/imammb/dqx006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/09/2017] [Accepted: 06/05/2017] [Indexed: 12/30/2022]
Abstract
In the past few years, proton therapy has taken the centre stage in treating various tumour types. The primary contribution of this study is to investigate the tumour control probability (TCP), relapse time and the corresponding secondary cancer risks induced by proton beam radiation therapy. We incorporate tumour relapse kinetics into the TCP framework and calculate the associated second cancer risks. To calculate proton therapy-induced secondary cancer induction, we used the well-known biologically motivated mathematical model, initiation-inactivation-proliferation formalism. We used the available in vitro data for the linear energy transfer (LET) dependence of cell killing and mutation induction parameters. We evaluated the TCP and radiation-induced second cancer risks for protons in the clinical range of LETs, i.e. approximately 8 $\mathrm{keV/\mu m}$ for the tumour volume and 1-3 $\mathrm{keV/\mu m}$ for the organs at risk. This study may serve as a framework for further work in this field and elucidates proton-induced TCP and the associated secondary cancer risks, not previously reported in the literature. Although studies with a greater number of cell lines would reduce uncertainties within the model parameters, we argue that the theoretical framework presented within is a sufficient rationale to assess proton radiation TCP, relapse and carcinogenic effects in various treatment plans. We show that compared with photon therapy, proton therapy markedly reduces the risk of secondary malignancies and for equivalent dosing regimens achieves better tumour control as well as a reduced primary recurrence outcome, especially within a hypo-fractionated regimen.
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Affiliation(s)
- V S K Manem
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - A Dhawan
- Department of Oncology, University of Oxford, Oxford, UK
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Jouglar E, Wagner A, Delpon G, Campion L, Meingan P, Bernier V, Demoor-Goldschmidt C, Mahé MA, Lacornerie T, Supiot S. Can We Spare the Pancreas and Other Abdominal Organs at Risk? A Comparison of Conformal Radiotherapy, Helical Tomotherapy and Proton Beam Therapy in Pediatric Irradiation. PLoS One 2016; 11:e0164643. [PMID: 27764132 PMCID: PMC5072698 DOI: 10.1371/journal.pone.0164643] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/28/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Late abdominal irradiation toxicity during childhood included renal damage, hepatic toxicity and secondary diabetes mellitus. We compared the potential of conformal radiotherapy (CRT), helical tomotherapy (HT) and proton beam therapy (PBT) to spare the abdominal organs at risk (pancreas, kidneys and liver- OAR) in children undergoing abdominal irradiation. METHODS We selected children with abdominal tumors who received more than 10 Gy to the abdomen. Treatment plans were calculated in order to keep the dose to abdominal OAR as low as possible while maintaining the same planned target volume (PTV) coverage. Dosimetric values were compared using the Wilcoxon signed-rank test. RESULTS The dose distribution of 20 clinical cases with a median age of 8 years (range 1-14) were calculated with different doses to the PTV: 5 medulloblastomas (36 Gy), 3 left-sided and 2 right-sided nephroblastomas (14.4 Gy to the tumor + 10.8 Gy boost to para-aortic lymphnodes), 1 left-sided and 4 right-sided or midline neuroblastomas (21 Gy) and 5 Hodgkin lymphomas (19.8 Gy to the para-aortic lymphnodes and spleen). HT significantly reduced the mean dose to the whole pancreas (WP), the pancreatic tail (PT) and to the ipsilateral kidney compared to CRT. PBT reduced the mean dose to the WP and PT compared to both CRT and HT especially in midline and right-sided tumors. PBT decreased the mean dose to the ispilateral kidney but also to the contralateral kidney and the liver compared to CRT. Low dose to normal tissue was similar or increased with HT whereas integral dose and the volume of normal tissue receiving at least 5 and 10 Gy were reduced with PBT compared to CRT and HT. CONCLUSION In children undergoing abdominal irradiation therapy, proton beam therapy reduces the dose to abdominal OAR while sparing normal tissue by limiting low dose irradiation.
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Affiliation(s)
- Emmanuel Jouglar
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint Herblain, 44800 France
| | - Antoine Wagner
- Department of Medical Physics, Centre Oscar Lambret, 3 rue Frédéric Combemale, Lille, 59000 France
| | - Grégory Delpon
- Department of Medical Physics, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint Herblain, 44800 France
| | - Loïc Campion
- Department of Statistics, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint-Herblain, 44800 France
| | - Philippe Meingan
- Department of Radiology, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint-Herblain, 44800 France
| | - Valérie Bernier
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, Vandœuvre-lès-Nancy, 54519 France
| | - Charlotte Demoor-Goldschmidt
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint Herblain, 44800 France
| | - Marc-André Mahé
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint Herblain, 44800 France
| | - Thomas Lacornerie
- Department of Medical Physics, Centre Oscar Lambret, 3 rue Frédéric Combemale, Lille, 59000 France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, boulevard Jacques Monod, Saint Herblain, 44800 France
- * E-mail:
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Benassi M, Di Murro L, Tolu B, Ponti E, Falco MD, Rossi C, Bagalà P, di Cristino D, Murgia A, Cicchetti S, Bruni C, Morelli P, Lancia A, Santoni R. Technical solutions to reduce mediastinal irradiation in young patients undergoing treatment for lymphomas: Preliminary experience. Med Dosim 2016; 41:281-284. [DOI: 10.1016/j.meddos.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 05/30/2016] [Accepted: 06/16/2016] [Indexed: 11/29/2022]
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The role of radiotherapy in Hodgkin's lymphoma: what has been achieved during the last 50 years? BIOMED RESEARCH INTERNATIONAL 2015; 2015:485071. [PMID: 25705661 PMCID: PMC4331316 DOI: 10.1155/2015/485071] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/18/2014] [Indexed: 12/23/2022]
Abstract
Currently, Hodgkin's lymphoma (HL) has an excellent clinical outcome, with overall survival of approximately 90% in early stages of the disease. Based on young age of the majority of patients at the time of diagnosis and their long survival time, increased attention has been focused on long-term toxicity of therapy. While novel, directly targeting antitumor agents, with an excellent safety profile, have been developed for HL treatment, the role of radiotherapy is still debated. Radiotherapy may induce cardiovascular disease and impairment of thyroid or pulmonary function and, most importantly, may lead to development of secondary cancers. As a consequence, the current radiation therapy planning paradigm is mainly focused on a reduction of field size. As it was investigated in clinical trials regional therapy is as effective as extended field radiotherapy, but less toxic. Although chemotherapy is the mainstay of HL treatment, consolidative involved field radiation therapy is still considered to be the standard of care in both early and advanced stages. Recently, further field reduction has been investigated to further decrease the late radiation-induced toxicity. In this paper we describe the role and safety profile of radiotherapy in the past and present and hope for the novel techniques in the future.
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Cella L, Conson M, Pressello MC, Molinelli S, Schneider U, Donato V, Orecchia R, Salvatore M, Pacelli R. Hodgkin's lymphoma emerging radiation treatment techniques: trade-offs between late radio-induced toxicities and secondary malignant neoplasms. Radiat Oncol 2013; 8:22. [PMID: 23360559 PMCID: PMC3641014 DOI: 10.1186/1748-717x-8-22] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/20/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Purpose of this study is to explore the trade-offs between radio-induced toxicities and second malignant neoplasm (SMN) induction risk of different emerging radiotherapy techniques for Hodgkin's lymphoma (HL) through a comprehensive dosimetric analysis on a representative clinical model. METHODS Three different planning target volume (PTVi) scenarios of a female patient with supradiaphragmatic HL were used as models for the purpose of this study. Five treatment radiation techniques were simulated: an anterior-posterior parallel-opposed (AP-PA), a forward intensity modulated (FIMRT), an inverse intensity modulated (IMRT), a Tomotherapy (TOMO), a proton (PRO) technique. A radiation dose of 30 Gy or CGE was prescribed. Dose-volume histograms of PTVs and organs-at-risk (OARs) were calculated and related to available dose-volume constraints. SMN risk for breasts, thyroid, and lungs was estimated through the Organ Equivalent Dose model considering cell repopulation and inhomogeneous organ doses. RESULTS With similar level of PTVi coverage, IMRT, TOMO and PRO plans generally reduced the OARs' dose and accordingly the related radio-induced toxicities. However, only TOMO and PRO plans were compliant with all constraints in all scenarios. For the IMRT and TOMO plans an increased risk of development of breast, and lung SMN compared with AP-PA and FIMRT techniques was estimated. Only PRO plans seemed to reduce the risk of predicted SMN compared with AP-PA technique. CONCLUSIONS Our model-based study supports the use of advanced RT techniques to successfully spare OARs and to reduce the risk of radio-induced toxicities in HL patients. However, the estimated increase of SMNs' risk inherent to TOMO and IMRT techniques should be carefully considered in the evaluation of a risk-adapted therapeutic strategy.
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Affiliation(s)
- Laura Cella
- Institute of Biostructures and Bioimaging, National Council of Research (CNR), Napoli, Italy
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Napoli, Napoli, Italy
| | - Manuel Conson
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Napoli, Napoli, Italy
| | | | - Silvia Molinelli
- Unit of Medical Physics, Centro Nazionale di Adroterapia Oncologica Foundation, Pavia, Italy
| | - Uwe Schneider
- Vetsussie Faculty, University of Zürich and Radiotherapy, Hirslanden, Aarau, Switzerland
| | - Vittorio Donato
- Department of Radiation Oncology, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Roberto Orecchia
- Advanced Radiotherapy Center, European Institute of Oncology, Milano, Italy
| | - Marco Salvatore
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Napoli, Napoli, Italy
| | - Roberto Pacelli
- Institute of Biostructures and Bioimaging, National Council of Research (CNR), Napoli, Italy
- Department of Diagnostic Imaging and Radiation Oncology, University “Federico II” of Napoli, Napoli, Italy
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Cella L, Conson M, Caterino M, De Rosa N, Liuzzi R, Picardi M, Grimaldi F, Solla R, Farella A, Salvatore M, Pacelli R. Thyroid V30 Predicts Radiation-Induced Hypothyroidism in Patients Treated With Sequential Chemo-Radiotherapy for Hodgkin’s Lymphoma. Int J Radiat Oncol Biol Phys 2012; 82:1802-8. [PMID: 21514076 DOI: 10.1016/j.ijrobp.2010.09.054] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/08/2010] [Accepted: 09/21/2010] [Indexed: 12/18/2022]
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Mascarin M, Giugliano FM, Coassin E, Drigo A, Chiovati P, Dassie A, Franchin G, Minatel E, Trovò MG. Helical tomotherapy in children and adolescents: dosimetric comparisons, opportunities and issues. Cancers (Basel) 2011; 3:3972-90. [PMID: 24213120 PMCID: PMC3763405 DOI: 10.3390/cancers3043972] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 10/07/2011] [Accepted: 10/17/2011] [Indexed: 01/26/2023] Open
Abstract
Helical Tomotherapy (HT) is a highly conformal image-guided radiation technique, introduced into clinical routine in 2006 at the Centro di Riferimento Oncologico Aviano (Italy). With this new technology, intensity-modulated radiotherapy (IMRT) is delivered using a helicoidal method. Here we present our dosimetric experiences using HT in 100 children, adolescents and young adults treated from May 2006 to February 2011. The median age of the patients was 13 years (range 1-24). The most common treated site was the central nervous system (50; of these, 24 were craniospinal irradiations), followed by thorax (22), head and neck (10), abdomen and pelvis (11), and limbs (7). The use of HT was calculated in accordance to the target dose conformation, the target size and shape, the dose to critical organs adjacent to the target, simultaneous treatment of multiple targets, and re-irradiation. HT has demonstrated to improve target volume dose homogeneity and the sparing of critical structures, when compared to 3D Linac-based radiotherapy (RT). In standard cases this technique represented a comparable alternative to IMRT delivered with conventional linear accelerator. In certain cases (e.g., craniospinal and pleural treatments) only HT generated adequate treatment plans with good target volume coverage. However, the gain in target conformality should be balanced with the spread of low-doses to distant areas. This remains an open issue for the potential risk of secondary malignancies (SMNs) and longer follow-up is mandatory.
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Affiliation(s)
- Maurizio Mascarin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (F.M.G.); (E.C.)
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0434-659-523; Fax: +39-0434-659-524
| | - Francesca Maria Giugliano
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (F.M.G.); (E.C.)
- Seconda Università di Napoli, Napoli 80138, Italy
| | - Elisa Coassin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (F.M.G.); (E.C.)
| | - Annalisa Drigo
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy
| | - Paola Chiovati
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy
| | - Andrea Dassie
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy
| | - Giovanni Franchin
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
| | - Emilio Minatel
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
| | - Mauro Gaetano Trovò
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
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Cella L, Liuzzi R, Conson M, Torre G, Caterino M, De Rosa N, Picardi M, Camera L, Solla R, Farella A, Salvatore M, Pacelli R. Dosimetric predictors of asymptomatic heart valvular dysfunction following mediastinal irradiation for Hodgkin's lymphoma. Radiother Oncol 2011; 101:316-21. [PMID: 21925755 DOI: 10.1016/j.radonc.2011.08.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/04/2011] [Accepted: 08/08/2011] [Indexed: 12/25/2022]
Abstract
PURPOSE To identify dose-heart-volume constraints that correlate with the risk of developing asymptomatic valvular defects (VD) in Hodgkin's lymphoma (HL) patients treated with three-dimensional radiotherapy (RT). PATIENTS AND METHODS Fifty-six patients undergoing cytotoxic chemotherapy (CHT) and involved-field radiation treatment for HL were retrospectively analyzed. Electro-echocardiography was performed before CHT, after CHT, and after RT. For the entire heart, for right and left ventricle (RV, LV), right and left atrium (RA, LA) percentage of volume exceeding 5-30Gy in increment of 5Gy (V(x)), and dosimetric parameters were calculated using 1.6Gy fraction as reference. To evaluate clinical and dosimetric factors possibly associated with VD, univariate and multivariate logistic regression analyses were performed. RESULTS At a median follow up of 70.5 months, 32.1% of patients developed VD (regurgitation and/or stenosis): 25.0% developed mitral, 5.4% developed aortic, and 14.3% tricuspid VD. In particular the percentage of LA exceeding 25Gy (LA-V(25)) and the percentage of LV exceeding 30Gy (LV-V(30)) correlated with mitral and aortic VD with an odds ratio (OR) of 5.7 (LA-V(25)>63.0% vs. LA-V(25)≤63.0%) and OR of 4.4 (LV-V(30)>25% vs. LV-V(30)≤25%), respectively. RV-V(30) correlated with tricuspid VD (OR=7.2, RV-V(30)>65% vs. RV-V(30)≤65%). CONCLUSION LA-V(25), LV- and RV-V(30) prove to be predictors of asymptomatic alteration of valve functionality.
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Affiliation(s)
- Laura Cella
- Institute of Biostructure and Bioimaging, National Research Council of Italy, Naples, Italy
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Mesbah L, Matute R, Usychkin S, Marrone I, Puebla F, Mínguez C, García R, García G, Beltrán C, Marsiglia H. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity. Radiat Oncol 2011; 6:102. [PMID: 21871078 PMCID: PMC3224656 DOI: 10.1186/1748-717x-6-102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/26/2011] [Indexed: 01/08/2023] Open
Abstract
Background Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. Methods In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. Results The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. Conclusion HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly selected pediatric patient cohort with clinical features of poor prognosis and/or aggressive therapy needed. Despite of a dosimetrical advantage of HT technique, an exhaustive analysis of long-term follow-up data is needed to assess late toxicity, especially in this potentially sensitive to radiation population.
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Affiliation(s)
- Latifa Mesbah
- Radiotherapy Department, Instituto Madrileño de Oncología (Grupo IMO), Madrid, Spain
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Kirova YM, Chargari C. Applications of new irradiation modalities in patients with lymphoma: Promises and uncertainties. World J Radiol 2011; 3:66-9. [PMID: 21512653 PMCID: PMC3080052 DOI: 10.4329/wjr.v3.i3.66] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 03/02/2011] [Accepted: 03/09/2011] [Indexed: 02/06/2023] Open
Abstract
New highly conformal irradiation modalities have emerged for treatment of Hodgkin lymphoma. Helical tomotherapy offers both intensity-modulated irradiation and accurate patient positioning and was shown to significantly decrease radiation doses to the critical organs. Here we review some of the most promising applications of helical tomotherapy in Hodgkin disease. By decreasing doses to the heart or the breast, helical tomotherapy might decrease the risk of long-term cardiac toxicity or secondary breast cancers, which are major concerns in patients receiving chest radiotherapy. Other strategies, such as debulking radiotherapy prior to stem cell transplantation or total lymphoid irradiation may be clinically relevant. However, helical tomotherapy may also increase the volume of tissues that receive lower doses, which has been implicated in the carcinogenesis process. Prospective assessments of these new irradiation modalities of helical tomotherapy are required to confirm the potential benefits of highly conformal therapies applied to hematological malignancies.
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