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The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma

Jorgensen, Anni Y.S. ; Maraldo, Maja V. ; Brodin, Nils Patrik ; Aznar, Marianne C. ; Vogelius, Ivan R. ; Rosenschöld, P. M.A. LU orcid ; Petersen, Peter M. and Specht, Lena (2013) In Acta Oncologica 52(7). p.1559-1565
Abstract

Introduction. The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. Material and methods. We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with... (More)

Introduction. The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. Material and methods. We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. Results. Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p < 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p < 0.001). Conclusions. The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.

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publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Oncologica
volume
52
issue
7
pages
1559 - 1565
publisher
Taylor & Francis
external identifiers
  • pmid:24047340
  • scopus:84884562924
ISSN
0284-186X
DOI
10.3109/0284186X.2013.813636
language
English
LU publication?
no
id
d2b2cd52-6f61-42c1-b6a8-92a6518a6177
date added to LUP
2023-07-19 17:05:32
date last changed
2024-04-05 21:22:43
@article{d2b2cd52-6f61-42c1-b6a8-92a6518a6177,
  abstract     = {{<p>Introduction. The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. Material and methods. We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. Results. Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p &lt; 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p &lt; 0.001). Conclusions. The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.</p>}},
  author       = {{Jorgensen, Anni Y.S. and Maraldo, Maja V. and Brodin, Nils Patrik and Aznar, Marianne C. and Vogelius, Ivan R. and Rosenschöld, P. M.A. and Petersen, Peter M. and Specht, Lena}},
  issn         = {{0284-186X}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1559--1565}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma}},
  url          = {{http://dx.doi.org/10.3109/0284186X.2013.813636}},
  doi          = {{10.3109/0284186X.2013.813636}},
  volume       = {{52}},
  year         = {{2013}},
}