Boyun ve mediasten tutulumlu hodgkin lenfoma olgularında Butterfly VMAT tekniği avantajlı mıdır?

Yıl 2020, Cilt: 11 Sayı: 4, 274 - 281, 30.09.2020

Ebru Atasever Akkaş , Olgu Güvenç

https://doi.org/10.18663/tjcl.776107

Cited By: 1

Öz

Amaç: Bu çalışmada, erken evre Hodgkin lenfoma (HL) tanılı bilateral boyun ve mediasten yerleşimli genç kadın ve erkek olgularda, üç boyutlu konformal radyoterapi (3DCRT) ile volumetric modulated arc therapy (VMAT) ve butterfly VMAT tekniklerinin dozimetrik olarak karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Erken evre HL'lı 20 hastaya radyoterapi uygulandı. Tüm plan verileri, hedef hacim ve kritik organ doz hacim histogramları karşılaştırıldı. Her üç teknik için konformite indeksi, homojenite indeksi ve % V107 farklılıkları değerlendirildi.
Bulgular: Sağ meme maksimum, V25, V30 ve sol meme maksimum, V20, 25, 30 değerleri ise 3DCRT planlamada diğer VMAT planlarında elde edilen değerlerden daha yüksek idi. Bu da istatistiksel olarak anlamlı bulundu. Akciğer V5 değerleri 3DCRT planlamasında, VMAT planlarından daha düşüktü ve V20, 25,30 değerleri ise VMAT planlarından istatistiksel olarak daha yüksekti. Sağ ve sol parotis ortalamaları, V5,20 25, 30 değerleri butterfly VMAT planlamasında diğer planlara göre anlamlı olarak daha düşüktü. Sağ parotis V20, V25 değerinin butterfly VMAT planlamasında, ikili karşılaştırmalarda VMAT planından daha düşük olduğu bulunmuştur.
Sonuçlar: Memede 20 Gy ve üzerinde VMAT, butterfly VMAT, 20 Gy ve altında ise 3DCRT tekniğinin daha avantajlı olduğu görülmektedir. Parotis dozları açısından ise butterfly VMAT’ın daha avantajlı olduğu görülmektedir.

Anahtar Kelimeler

Hodgkin lenfoma, radioterapi, butterfly

Is Butterfly VMAT technique advantageous in hodgkin lymphoma patients with neck and mediastinal involvement?

Öz

Aim: In this paper, comparative planning for Three dimensional conformal (3DCRT), volumetric modulated arc therapy (VMAT) ve butterfly VMAT in a young female and male cohort with bilateral neck and mediastinal involvement diagnosed with early-stage Hodgkin’s lymphoma (HL) and we report whether the butterfly technique is advantageous.
Material and Methods: 20 patients with early-stage HL were treated radiotherapy. All plan solutions were compared by target volume and critical organ dose-volume histograms. The conformity index, homogeneity index, and V107% differences were evaluated for all three techniques.
Results: Right breast max, V25, V30 and left breast max V20,25,30 values in 3DCRT planning. It was found to be higher than the values obtained in the plans, which was found to be statistically significant. Lung V5 values were lower in 3DCRT planning than VMAT plans, and V20, 25,30 values were statistically higher than VMAT plans. Right, and left parotid means, V5,20 25, 30 values were significantly lower in butterfly VMAT planning compared to other plans. The right parotid V20, V25 value was found to be lower in butterfly-VMAT planning than in the VMAT plan in bilateral comparisons.
Conclusion: VMAT, butterfly VMAT over 20 Gy in the breast, and 3DCRT techniques under 20 Gy are more advantageous in the examination of dose volumes of the organs at risk. İn terms of parotid doses, butterfly VMAT seems to be more advantageous.

Anahtar Kelimeler

Hodgkin’s lymphoma, radiotherapy, butterfly

Kaynakça

• 1. 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.
• 2. 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.
• 3. Noordijk EM, Carde P, Dupouy N et al. 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: 3128–35.
• 4. Hodgson DC. Late effects in the era of modern therapy for Hodgkin lymphoma. ASH Educ Program Book 2011; 2011: 323–9.
• 5. Clemente S, Oliviero C, Palma Get al. Auto-versus human-driven plan in mediastinal Hodgkin lymphoma radiation treatment. Radiation Oncology 2018; 13: 202.
• 6. Specht L, Yahalom J, Illidge T et al. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phy. 2014; 89: 854–62.
• 7. Weber DC, Peguret N, Dipasquale G, Cozzi L. Involved-node and Involved-field volumetric modulated arcvs fixed beam intensity-modulated radiotherapy for female patients with early-stage supra-diaphragmatic Hodgkin Lymphoma: a comparative planning study. Int J Radiat Oncol Biol Phys 2009; 75: 1578–86.
• 8. Van’tRiet A, Mak ACA, Moerland MA, Elders LH, Zee WZD. A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: Application to the prostate. Int J Radiat Oncol Biol Phys 1997; 37: 731–6.
• 9. İcru.org., http://www.icru.org, ICRU Reports are distributed by the ICRU Publications' Office, 1999.
• 10. 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.
• 11. Fiandra C, Filippi AR, Catuzzo P 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.
• 12. Jackson A, Kutcher GJ, Yorke ED. Probability of radiation- induced complications for normal tissues with parallel architecture subject to non-uniform irradiation. Med Phys 1993; 20: 613–25.
• 13. Travis LB, Hill DA, Dores GM et al. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA – J Am Med Assoc 2003; 290: 465–75.
• 14. Nieder C, Schill S, Kneschaurek P, Molls M. Comparison of three different mediastinal radiotherapy techniques in female patients: Impact on heart sparing and dose to the breasts. Radiother Oncol. 2007; 82: 301–7.
• 15. Sachs RK, Shuryak I, Brenner D, Fakir H, Hlatky L, Hahnfeldt P. Second cancers after fractionated radiotherapy: stochastic population Dynamics effects. J Theor Biol 2007; 249: 518-31.
• 16. Constine LS, Tarbell N, Hudson MM et al. Subsequent malignancies in children treated for Hodgkin’s disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys 2011; 81: 490-7.
• 17. 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. Int J Radiat Oncol Biol Phys 2011; 81: 490–7.
• 18. Hull MC, Morris CG, Pepine CJ et al.Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA 2003; 290: 2831–7.
• 19. Ghalibafian M, Beaudre A, Girinsky T. Heart and coronary artery protection in patients with mediastinal Hodgkin lymphoma treated with intensity-modulated radiotherapy: dose constraints to virtual volumes or to organs at risk? Radiother Oncol 2008; 87: 82–8.
• 20. Girinsky T, Ghalibafian M. Radiation treatment in non-Hodgkin’s lymphomas: present and future directions. Cancer Radiother 2005; 9: 422–6.
• 21. Constine LS, Donaldson SS, McDougall IR, Cox RS, Link MP, Kaplan HS.Thyroid dysfunction after radiotherapy in children with Hodgkin’s disease. Cancer 1984; 53: 878–83.
• 22. Sklar C, Whitton J, Mertens A et al. Abnormalities of the thyroid in survivors of Hodgkin’s disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 2000; 85: 3227–32.
• 23. Imanimoghaddam M, Rahrooh M, Tafakhori Z, Zahedanaraki S, Homaeieshandiz F. Changes of parotid and submandibular glands caused by radiotherapy-an ultrasound evaluation. Dentomaxillofac Radiol 2012; 41: 379–84.
• 24. Almstahl A, Wikström M, &Groenink J. Lactoferrin, amylase and mucin MUC5 B and their relation to the oral microflora in hyposalivation of differents origin. Oral Microbiology and Immunology 2001; 16: 34–52.
• 25. Dijkema T, Terhaard CHJ, Roesink JM, Raaijmakers CP, Van den Keijbus PA, et al. MUC5 B levels in submandibular gland saliva of patients treated with radiotherapy for head-and-neck cancer: A pilot study. Radiation Oncology 2012; 15: 91–7.