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

Yıl 2021, Sayı: 31, 320 - 325, 31.12.2021

Hamit Başaran , Gökçen İnan

https://doi.org/10.31590/ejosat.1010145

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

Teşekkür

Makalemiz Aralık 2021 özel sayısı kapsamında değerlendirmek üzere gönderildi. iyi çalışmalar dilerim.

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

Öz

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.

Anahtar Kelimeler

butterfly, rainbow, hodgkin's lymphoma

Kaynakça

• Engert A, PlütschowA, Eich HT et al. Reduced treatment intensity in patients with early-stage Hodgkin’s lymphoma. N Engl J Med 2010; 363: 640–52.
• Eich HT, Diehl V, Gorgen H et al. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin’s lymphoma: Final analysis of the German Hodgkin Study Group HD11 trial. J Clin Oncol 2010; 28: 4184, 4191, 4207.
• Girinsky T, van der Maazen R, Specht L, Aleman B, Poortmans P, Lievens Y, Meijnders P, Ghalibafian M, Meerwaldt J, Noordijk E: Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol 2006, 79:270–277.
• Bonadonna G, Bonfante V, Viviani S, Di Russo A, Villani F, Valagussa P: ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin’s disease: long-term results. J Clin Oncol 2004, 22:2835–2841.
• Noordijk EM, Carde P, Dupouy N, Hagenbeek A, Krol AD, Kluin-Nelemans JC, Tirelli U, Monconduit M, Thomas J, Eghbali H, Aleman BM, Bosq J, Vovk M, Verschueren TA, Peny AM, Girinsky T, Raemaekers JM, Henry-Amar M: Combined-modality therapy for clinical stage I or II Hodgkin’s lymphoma: long-term results of the European organisation for research and treatment of cancer H7 randomized controlled trials. J Clin Oncol 2006, 24:3128–3135.
• Fiandra C, Filippi A.R, Catuzzo P, Botticella A. et al. Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin’s lymphoma: dosimetric comparison and clinical considerations. Radiation Oncology 2012, 7:186.
• Maraldo MV, Specht L. A decade of comparative dose planning studies for early-stage Hodgkin lymphoma: What can we learn? Int J Radiat Oncol Biol Phys 2014; 90: 1126–35.
• Hodgson DC, Gilbert ES, Dores GM, Schonfeld SJ, Lynch CF, Storm H, Hall P, Langmark F, Pukkala E, Andersson M, Kaijser M, Joensuu H, Fosså SD, Travis LB: Long term solid cancer risk among 5-year survivors of Hodgkin’s lymphoma. J Clin Oncol 2007, 25:1489–1497.
• Ng AK, Bernardo MV, Weller E, Backstrand K, Silver B, Marcus KC, Tarbell NJ, Stevenson MA, Friedberg JW, Mauch PM: Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: Long term risks and risk factors. Blood 2002, 100:1989–1996.
• Swerdlow AJ, Higgins CD, Smith P, Cunningham D, Hancock BW, Horwich A, Hoskin PJ, Lister A, Radford JA, Rohatiner AZ, Linch DC: Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl cancer Inst 2007, 99:206–214.
• Moser EC, Noordijk EM, van Leeuwen FE, le Cessie S, Baars JW, Thomas J, Carde P, Meerwaldt JH, van Glabbeke M, Kluin-Nelemans HC: Long-term risk of cardiovascular disease after treatment for aggressive non-Hodgkin lymphoma. Blood 2006, 107:2912–2919.
• Fermé C, Eghbali H, Meerwaldt JH. et al. EORTC-GELA H8 Trial. Chemotherapy plus involved-field radiation in early-stage Hodgkin's disease. N Engl J Med. 2007 Nov 8;357(19):1916-27. doi: 10.1056/NEJMoa064601. PMID: 17989384.
• Fiandra C, Filippi AR, Catuzzo P, Botticella A, Ciammella P, Franco P, Borca VC, Ragona R, Tofani S, Ricardi U. Different IMRT solutions vs. 3D-conformal radiotherapy in early stage Hodgkin's Lymphoma: dosimetric comparison and clinical considerations. Radiat Oncol. 2012 Nov 2;7:186. doi: 10.1186/1748-717X-7-186. PMID: 23122028; PMCID: PMC3502518.
• ICRU Report 83 Prescribing, recording, and Reporting Photon Beam İntensity Modulated Radiation Therapy (IMRT). J ICRU, 2010. 10:1 106.
• Oeffinger KC, Mertens AC, Sklar CA, et al. Chronic health conditions in adult survivors of childhood cancer. New Engl J Med. 2006; 355:1572-1582.
• Maraldo MV, Specht L. A decade of comparative dose planning studies for early-stage Hodgkin lymphoma: What can we learn? Int J Radiat Oncol Biol Phys 2014; 90: 1126 35.
• Goodman KA, Toner S, Hunt M, Wu EJ, Yahalom J. Intensity-modulated radiotherapy for lymphoma involving the mediastinum. Int J Radiat Oncol Biol Phys 2005; 62: 198–206.
• Sachs RK, Shuryak I, Brenner D, Fakir H, Hlatky L, Hahnfeldt P: Second cancers after fractionated radiotherapy: stochastic population dynamicseffects. J Theor Biol 2007, 249:518–531.
• Constine LS, Tarbell N, Hudson MM, Schwartz C et al. Subsequent malignancies in children treated for Hodgkin’s disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys 2008, 72:24–33.
• Weber DC, Johanson S, Peguret N, Cozzi L, Olsen DR: Predicted risk of radiation-induced cancers after involved field and involved node radiotherapy with or without intensity modulation for early-stage hodgkin lymphoma in female patients. Int J Radiat Oncol Biol Phys 2011, 81:490–497.
• Akkaş EA, Güvenç O. Boyun ve mediasten tutulumlu hodgkin lenfoma olgularında Butterfly VMAT tekniği avantajlı mıdır?. Turk J Clin Lab 2020; 4: 274-281. Doi: 10.18663/tjcl.776107
• Fiandra C, Filippi AR, Catuzzo P et al. Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin’s lympho¬ma: dosimetric comparison and clinical considerations. Radiati¬on Oncology 2012, 7: 186.
• Lloyd S, Aurand A, Wagner H. Hodgkin Lymphoma With Bulky Mediastinal Disease: A Comparison of AP/PA, IMRT, and Volumetric Arc Plans. Int J Radiat Oncol Biol Phys 2014; 90(1): 672