Mediastinal Lymphoma
Hodgkin lymphoma and primary mediastinal large B cell lymphoma (a form of non-Hodgkin lymphoma) are lymphomas that commonly involve the mediastinum and typically affect adolescents and young adults. Owing to the young age at presentation and excellent cur
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Bradford S. Hoppe, Stella Flampouri, Christine Hill-Kayser, and John P. Plastaras
Contents 23.1 23.2 23.3 23.4
Introduction................................................................................................................... 369 Simulation, Target Delineation, Radiation Dose, and Fractionation............................ 371 Passive-Scattering Treatment Planning......................................................................... 373 Pencil-Beam Scanning.................................................................................................. 376 23.4.1 Irregular and Noncontiguous Targets.............................................................. 376 23.4.2 Long/Wide Targets.......................................................................................... 378 23.4.3 Motion Management....................................................................................... 378 23.4.4 Beam-Angle Selection.................................................................................... 378 23.5 Future Developments.................................................................................................... 379 References................................................................................................................................ 379
23.1 Introduction Hodgkin lymphoma (HL) is a rare diagnosis, with only 9000 cases diagnosed in the USA annually [1]; however, it is the most common malignancy diagnosed in adolescents and young adults 15–19 years of age [2]. Radiation is currently used as primary treatment for early-stage nodular lymphocyte-predominant HL and as consolidation after chemotherapy in early-stage classic HL and bulky mediastinal stage III/IV as well as for slowly responding sites of disease. Approximately 60–70% of
B.S. Hoppe (*) • S. Flampouri Department of Radiation Oncology, University of Florida College of Medicine, 2000 SW Archer Road, Gainesville,, FL 33710, USA e-mail: [email protected] C. Hill-Kayser • J.P. Plastaras Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA © Springer International Publishing Switzerland 2018 N. Lee et al. (eds.), Target Volume Delineation and Treatment Planning for Particle Therapy, Practical Guides in Radiation Oncology, https://doi.org/10.1007/978-3-319-42478-1_23
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HL patients will have mediastinal involvement, and 30% of all HL patients will receive radiation [3]. Non-Hodgkin lymphoma (NHL) is comprised of over 100 subtypes with approximately 66,000 cases diagnosed in the USA annually [1]. Primary mediastinal large B-cell lymphoma (PMLBCL) arises from the thymic B cells and comprises 7% of all diffuse large B-cell lymphomas or 2.4% of all NHL [4]. PMLBCL typically affects younger patients (those in their 30s) with a predominance of females over males (3:2) [5]. Standard treatment for HL incorporates chemotherapy with radiation delivered to all sites of initial involvement for e
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