Evaluation of Target Volume and Critical Organ Doses in Hodgkin Lymphoma Cases Using Three Different Radiotherapy Techniques

Abstract

Objective: In this study, it was aimed to compare the dosimetric methods of field-in-field ( (FinF), butterfly intensity modulated radiotherapy (B-IMRT), and rainbow intensity modulated radiotherapy (R-IMRT) in Hodgkin Lymphoma (HL) cases. Methods: Plans were evaluated in terms of planned target volume (PTV) doses, conformity index (CI), homogeneity index (HI), and monitor unit (MUs). In addition, Dort (Gy), V5, V10, V20 and V30 doses for total lung, heart, spinal cord, thyroid, larynx, esophagus, right parotid and left parotid were compared as critical organs. Results: The mean doses for PTV were 30.19±0.17 Gy for the FinF technique, and 30.74±0.19 Gy and 30.80±0.13 for the B-IMART and R-IMRT techniques, respectively. The average doses received by PTV for the three techniques are similar. It was observed that the mean bilateral lung doses for the plans were similar, but it was found to be significantly lower in the low-dose volume FinF plans such as V5, and high-dose volume such as V20 and V30 in the B-IMART and R-IMART plans (p<0.05). Dort and V30 dose values for thyroid and larynx were found to be significantly lower in B-IMART and R-IMRT plans (p values 0.001, 0.003, respectively). Conclusion: In the treatment of HL, B-IMART and R-IMRT techniques seem to be more advantageous than FinF technique in high dose volumes such as V20 and V30. In HL treatments, individual planning can be preferred by looking at the doses taken by critical structures.

Keywords

• butterfly
• rainbow
• hodgkin's lymphoma

Hodgkin Lenfoma Olgularında Üç Farklı Radyoterapi Tekniği Kullanılarak Hedef Hacim ve Kritik Organ Dozlarının Retrospektif İncelenmesi

Öz

Amaç: Bu çalışmamızda bilateral boyun ve mediasten tutulumu olan Hodgkin Lenfoma (HL) olgularında alan içinde alan (Field in Field (FinF)), butterfly yoğunluk ayarlı radyoterapi (B-YART) ve rainbow yoğunluk ayarlı radyoterapi (R-YART) tekniklerinin dozimetrik olarak karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Planlar planlanan hedef hacim (Planned Target Volume-(PTV)) dozları, konformite indeksi (CI), homojenite indeksi (HI) ve monitör ünit (MUs) açısından değerlendirildi. Ayrıca kritik organlar olarak total akciğer, kalp, spinal kord, tiroid, larenks, özafagus, sağ parotis ve sol parotis için Dort (Gy), V5, V10, V20 ve V30 dozları karşılaştırıldı. Bulgular: PTV için ortalama dozlar FinF tekniği için 30.19±0.17 Gy iken, B-YART ve R-YART teknikleri için sırasıyla 30.74±0.19 Gy ve 30.80±0.13' dir. Üç teknik için PTV’ nin aldığı ortalama dozlar benzerdir. Planlar için bilateral akciğer ortalama dozlarının benzer olduğu görüldü ancak V5 gibi düşük doz alan hacim FinF planlarında, V20 ve V30 gibi yüksek doz alan hacim B-YART ve R-YART planlarında anlamlı olarak düşük bulundu (p<0.05). Tiroid ve larenks için Dort ve V30 doz değerleri B-YART ve R-YART planlarında anlamlı şekilde düşük olduğu görüldü (p değerleri sırası ile 0.001, 0.003). Sonuç: HL tedavisinde V20 ve V30 gibi yüksek doz alan hacimlerde B-YART ve R-YART tekniklerinin FinF tekniğine göre daha avantajlı olduğu görülmektedir. HL tedavilerinde kritik yapıların aldığı dozlara bakılarak kişiye uygun planlama tercih edilebilir.

Anahtar Kelimeler

• Butterfly
• Hodgkin lenfoma
• rainbow

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