Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin's lymphoma: dosimetric comparison and clinical considerations

Christian Fiandra, Andrea R. Filippi, Paola Catuzzo, Angela Botticella, Patrizia Ciammella, Pierfrancesco Franco, Valeria C. Borca, Riccardo Ragona, Santi Tofani, Umberto Ricardi

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Abstract

Background: Radiotherapy in Hodgkin's Lymphoma (HL) is currently evolving with new attempts to further reduce radiation volumes to the involved-node concept (Involved Nodes Radiation Therapy, INRT) and with the use of intensity modulated radiotherapy (IMRT). Currently, IMRT can be planned and delivered with several techniques, and its role is not completely clear. We designed a planning study on a typical dataset drawn from clinical routine with the aim of comparing different IMRT solutions in terms of plan quality and treatment delivery efficiency.Methods: A total of 10 young female patients affected with early stage mediastinal HL and treated with 30 Gy INRT after ABVD-based chemotherapy were selected from our database. Five different treatment techniques were compared: 3D-CRT, VMAT (single arc), B-VMAT (" butterfly" , multiple arcs), Helical Tomotherapy (HT) and Tomodirect (TD). Beam energy was 6 MV, and all IMRT planning solutions were optimized by inverse planning with specific dose-volume constraints on OAR (breasts, lungs, thyroid gland, coronary ostia, heart). Dose-Volume Histograms (DVHs) and Conformity Number (CN) were calculated and then compared, both for target and OAR by a statistical analysis (Wilcoxon's Test).Results: PTV coverage was reached for all plans (V95% ≥ 95%); highest mean CN were obtained with HT (0.77) and VMAT (0.76). B-VMAT showed intermediate CN mean values (0.67), while the lowest CN were obtained with TD (0.30) and 3D-CRT techniques (0.30). A trend of inverse correlation between higher CN and larger healthy tissues volumes receiving low radiation doses was shown for lungs and breasts. For thyroid gland and heart/coronary ostia, HT, VMAT and B-VMAT techniques allowed a better sparing in terms of both Dmean and volumes receiving intermediate-high doses compared to 3D-CRT and TD.Conclusions: IMRT techniques showed superior target coverage and OAR sparing, with, as an expected consequence, larger volumes of healthy tissues (lungs, breasts) receiving low doses. Among the different IMRT techniques, HT and VMAT showed higher levels of conformation; B-VMAT and HT emerged as the planning solutions able to achieve the most balanced compromise between higher conformation around the target and smaller volumes of OAR exposed to lower doses (typical of 3D-CRT).

Original languageEnglish
Article number186
JournalRadiation Oncology
Volume7
Issue number1
DOIs
Publication statusPublished - Nov 2 2012

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Conformal Radiotherapy
Intensity-Modulated Radiotherapy
Hodgkin Disease
Breast
Radiotherapy
Lung
Thyroid Gland
Radiation
Butterflies

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin's lymphoma : dosimetric comparison and clinical considerations. / Fiandra, Christian; Filippi, Andrea R.; Catuzzo, Paola; Botticella, Angela; Ciammella, Patrizia; Franco, Pierfrancesco; Borca, Valeria C.; Ragona, Riccardo; Tofani, Santi; Ricardi, Umberto.

In: Radiation Oncology, Vol. 7, No. 1, 186, 02.11.2012.

Research output: Contribution to journalArticle

Fiandra, C, Filippi, AR, Catuzzo, P, Botticella, A, Ciammella, P, Franco, P, Borca, VC, Ragona, R, Tofani, S & Ricardi, U 2012, 'Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin's lymphoma: dosimetric comparison and clinical considerations', Radiation Oncology, vol. 7, no. 1, 186. https://doi.org/10.1186/1748-717X-7-186
Fiandra, Christian ; Filippi, Andrea R. ; Catuzzo, Paola ; Botticella, Angela ; Ciammella, Patrizia ; Franco, Pierfrancesco ; Borca, Valeria C. ; Ragona, Riccardo ; Tofani, Santi ; Ricardi, Umberto. / Different IMRT solutions vs. 3D-Conformal Radiotherapy in early stage Hodgkin's lymphoma : dosimetric comparison and clinical considerations. In: Radiation Oncology. 2012 ; Vol. 7, No. 1.
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T2 - dosimetric comparison and clinical considerations

AU - Fiandra, Christian

AU - Filippi, Andrea R.

AU - Catuzzo, Paola

AU - Botticella, Angela

AU - Ciammella, Patrizia

AU - Franco, Pierfrancesco

AU - Borca, Valeria C.

AU - Ragona, Riccardo

AU - Tofani, Santi

AU - Ricardi, Umberto

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N2 - Background: Radiotherapy in Hodgkin's Lymphoma (HL) is currently evolving with new attempts to further reduce radiation volumes to the involved-node concept (Involved Nodes Radiation Therapy, INRT) and with the use of intensity modulated radiotherapy (IMRT). Currently, IMRT can be planned and delivered with several techniques, and its role is not completely clear. We designed a planning study on a typical dataset drawn from clinical routine with the aim of comparing different IMRT solutions in terms of plan quality and treatment delivery efficiency.Methods: A total of 10 young female patients affected with early stage mediastinal HL and treated with 30 Gy INRT after ABVD-based chemotherapy were selected from our database. Five different treatment techniques were compared: 3D-CRT, VMAT (single arc), B-VMAT (" butterfly" , multiple arcs), Helical Tomotherapy (HT) and Tomodirect (TD). Beam energy was 6 MV, and all IMRT planning solutions were optimized by inverse planning with specific dose-volume constraints on OAR (breasts, lungs, thyroid gland, coronary ostia, heart). Dose-Volume Histograms (DVHs) and Conformity Number (CN) were calculated and then compared, both for target and OAR by a statistical analysis (Wilcoxon's Test).Results: PTV coverage was reached for all plans (V95% ≥ 95%); highest mean CN were obtained with HT (0.77) and VMAT (0.76). B-VMAT showed intermediate CN mean values (0.67), while the lowest CN were obtained with TD (0.30) and 3D-CRT techniques (0.30). A trend of inverse correlation between higher CN and larger healthy tissues volumes receiving low radiation doses was shown for lungs and breasts. For thyroid gland and heart/coronary ostia, HT, VMAT and B-VMAT techniques allowed a better sparing in terms of both Dmean and volumes receiving intermediate-high doses compared to 3D-CRT and TD.Conclusions: IMRT techniques showed superior target coverage and OAR sparing, with, as an expected consequence, larger volumes of healthy tissues (lungs, breasts) receiving low doses. Among the different IMRT techniques, HT and VMAT showed higher levels of conformation; B-VMAT and HT emerged as the planning solutions able to achieve the most balanced compromise between higher conformation around the target and smaller volumes of OAR exposed to lower doses (typical of 3D-CRT).

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