Target Definitions for Hodgkin Lymphoma: The Involved Node Radiation Field Concept
In the modern combined modality setting radiotherapy needs only be given to the initially involved tissue volume. Radiation fields have therefore become much smaller. This treatment approach makes highly accurate target definition mandatory. With the impl
- PDF / 3,577,817 Bytes
- 32 Pages / 547.087 x 737.008 pts Page_size
- 77 Downloads / 165 Views
Target Definitions for Hodgkin Lymphoma: The Involved Node Radiation Field Concept Theodore Girinsky, Mithra Ghalibafian, and Lena Specht
Contents 9.1
Introduction............................................................. 91
9.2
Imaging Procedure Guidelines for the Assessment of Initially Involved Lymph Nodes and the Design of Involved Node Radiation Fields............................................ 92
9.3
Assessment and Delineation of Initially Involved Lymph Nodes............................ 92 9.3.1 Introduction.............................................................. 92 9.3.2 Assessment of Initially Involved Lymph Nodes....... 94 9.4 Delineation of Involved Node Fields...................... 100 9.4.1 General Guidelines................................................... 100 9.4.2 Specific Guidelines................................................... 101 9.5
Treatment and Dose Prescription.......................... 110
9.6
Quality Assurance Programs................................. 111
9.7
Conclusions.............................................................. 116
References............................................................................ 122
T. Girinsky (*) Dept. of Radiation Oncology, Institut Gustave-Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cedex, France e-mail: [email protected] M. Ghalibafian Dept. of Radiation Oncology, Mahak Hospital, Tehran, Iran L. Specht Depts. of Oncology and Haematology, The Finsen Centre, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, 2100 Copenhagen, Denmark e-mail: [email protected]
9.1 Introduction The involved node radiation (INRT) field concept was developed approximately 10 years ago when two fundamental facts became acknowledged. The first was the deleterious effect of large radiation fields and high radiation doses in terms of late complications (cardiovascular and second cancers) (Aleman et al. 2003; Bhatia et al. 1996; Hancock et al. 1993; Mauch 1995; Ng et al. 2002; van Leeuwen et al. 2003). The second was that the effectiveness of the new chemotherapy regimens was being persistently demonstrated (Bonadonna et al. 2004). Nevertheless, local relapses continued to be a major cause of treatment failure in patients treated with chemotherapy alone (Biti et al. 1992; Longo et al. 1991; Pavlovsky et al. 1988). The basic assumption was that local relapses would occur preferentially, if not exclusively, in the initially involved nodes. This hypothesis was supported by Shahidi et al. who demonstrated that in patients with early-stage Hodgkin lymphoma (HL) treated with chemotherapy alone 83% of recurrences occurred in initially involved nodes, and in 45% it was the sole site of recurrence (Shahidi et al. 2006). We also assumed that adding a small amount of radiation (in terms of total dose and field size) to fewer cycles of less toxic chemotherapy regimens would improve outcome of combined modality therapies (Donaldson et al. 2007; Landman-Parker et al. 2000). We reasoned that this strategy would result in a reduc
Data Loading...
