OBJECTIVE: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. METHODS: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. RESULTS: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). CONCLUSION: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. ADVANCES IN KNOWLEDGE: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.
OBJECTIVE: Radiotherapy plays an important role in the management of lymphoma and many patients with lymphoma are cured with treatment. Risk of secondary malignancy and long-term cardiac and pulmonary toxicity from mediastinal radiotherapy exists. Delivery of radiotherapy using a deep inspiration breath-hold (DIBH) technique increases lung volume and has the potential to reduce dose to heart and lungs. We undertook a prospective study to assess the dosimetric differences in DIBH and free breathing (FB) plans in patients requiring mediastinal radiotherapy in clinical practice. METHODS: We performed both FB and DIBH planning scans on 35 consecutive patients with mediastinal lymphoma needing radiotherapy. Contours and plans were generated for both data sets and dosimetric data were compared. All patients were planned using volumetric modulated arc therapy (VMAT). Data were compared for FB and DIBH plans with each patient acting as their own control using the related-samples Wilcoxon signed rank test. RESULTS: DIBH significantly reduced lung doses (mean 10.6 vs 11.4Gy, p < 0.0005; V20 16.8 vs 18.3%, p = 0.001) and spinal cord maximum dose (20.6 vs 22.8Gy, p = 0.001). DIBH increased breast V4 (38.5% vs 31.8%, p = 0.006) and mean right breast dose (4.2 vs 3.6Gy, p = 0.010). There was no significant difference in heart doses when the entire study cohort was considered, however, mean heart dose tended to be lower with DIBH for upper mediastinal (UM) tumours (4.3 vs 4.9Gy, p = 0.05). CONCLUSION: Our study describes the potential benefit of DIBH in a population reflective of clinical practice. DIBH can decrease radiation dose to lungs, heart and spinal cord, however, may increase dose to breasts. DIBH is not always superior to FB, and the clinical significance of differences in dose to organs at risk in addition to the time required to treat patients with DIBH must be considered when deciding the most appropriate radiotherapy technique for each patient. ADVANCES IN KNOWLEDGE: To our knowledge, this is the largest study comparing DIBH and FB planning for patients with lymphoma receiving mediastinal radiotherapy in clinical practice. It demonstrates the impact of an increasingly common radiotherapy technique on dose to organs at risk and the subsequent potential for long-term radiotherapy side-effects.
Authors: Peter M Petersen; Marianne C Aznar; Anne K Berthelsen; Annika Loft; Deborah A Schut; Maja Maraldo; Mirjana Josipovic; Thomas L Klausen; Flemming L Andersen; Lena Specht Journal: Acta Oncol Date: 2014-07-15 Impact factor: 4.089
Authors: Tim Illidge; Lena Specht; Joachim Yahalom; Berthe Aleman; Anne Kiil Berthelsen; Louis Constine; Bouthaina Dabaja; Kavita Dharmarajan; Andrea Ng; Umberto Ricardi; Andrew Wirth Journal: Int J Radiat Oncol Biol Phys Date: 2014-05-01 Impact factor: 7.038
Authors: Amaury Paumier; Mithra Ghalibafian; Jennifer Gilmore; Anne Beaudre; Pierre Blanchard; Mohammed el Nemr; Farez Azoury; Hweej al Hamokles; Dimitri Lefkopoulos; Theodore Girinsky Journal: Int J Radiat Oncol Biol Phys Date: 2011-06-24 Impact factor: 7.038
Authors: Lena Specht; Joachim Yahalom; Tim Illidge; Anne Kiil Berthelsen; Louis S Constine; Hans Theodor Eich; Theodore Girinsky; Richard T Hoppe; Peter Mauch; N George Mikhaeel; Andrea Ng Journal: Int J Radiat Oncol Biol Phys Date: 2013-06-18 Impact factor: 7.038
Authors: Chelsea C Pinnix; Grace L Smith; Sarah Milgrom; Eleanor M Osborne; Jay P Reddy; Mani Akhtari; Valerie Reed; Isidora Arzu; Pamela K Allen; Christine F Wogan; Michele A Fanale; Yasuhiro Oki; Francesco Turturro; Jorge Romaguera; Luis Fayad; Nathan Fowler; Jason Westin; Loretta Nastoupil; Fredrick B Hagemeister; M Alma Rodriguez; Sairah Ahmed; Yago Nieto; Bouthaina Dabaja Journal: Int J Radiat Oncol Biol Phys Date: 2015-05-01 Impact factor: 7.038
Authors: Khinh Ranh Voong; Kelli McSpadden; Chelsea C Pinnix; Ferial Shihadeh; Valerie Reed; Mohammad R Salehpour; Isidora Arzu; He Wang; David Hodgson; John Garcia; Michalis Aristophanous; Bouthaina S Dabaja Journal: Radiat Oncol Date: 2014-04-15 Impact factor: 3.481