Involved-site image-guided intensity modulated versus 3d conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma

Andrea Riccardo Filippi, Patrizia Ciammella, Cristina Piva, Riccardo Ragona, Barbara Botto, Paolo Gavarotti, Francesco Merli, Umberto Vitolo, Cinzia Iotti, Umberto Ricardi

Research output: Contribution to journalArticle

Abstract

Purpose Image-guided intensity modulated radiation therapy (IG-IMRT) allows for margin reduction and highly conformal dose distribution, with consistent advantages in sparing of normal tissues. The purpose of this retrospective study was to compare involved-site IG-IMRT with involved-site 3D conformal RT (3D-CRT) in the treatment of early stage Hodgkin lymphoma (HL) involving the mediastinum, with efficacy and toxicity as primary clinical endpoints. Methods and Materials We analyzed 90 stage IIA HL patients treated with either involved-site 3D-CRT or IG-IMRT between 2005 and 2012 in 2 different institutions. Inclusion criteria were favorable or unfavorable disease (according to European Organization for Research and Treatment of Cancer criteria), complete response after 3 to 4 cycles of an adriamycin- bleomycin-vinblastine-dacarbazine (ABVD) regimen plus 30 Gy as total radiation dose. Exclusion criteria were chemotherapy other than ABVD, partial response after ABVD, total radiation dose other than 30 Gy. Clinical endpoints were relapse-free survival (RFS) and acute toxicity. Results Forty-nine patients were treated with 3D-CRT (54.4%) and 41 with IG-IMRT (45.6%). Median follow-up time was 54.2 months for 3D-CRT and 24.1 months for IG-IMRT. No differences in RFS were observed between the 2 groups, with 1 relapse each. Three-year RFS was 98.7% for 3D-CRT and 100% for IG-IMRT. Grade 2 toxicity events, mainly mucositis, were recorded in 32.7% of 3D-CRT patients (16 of 49) and in 9.8% of IG-IMRT patients (4 of 41). IG-IMRT was significantly associated with a lower incidence of grade 2 acute toxicity (P=.043). Conclusions RFS rates at 3 years were extremely high in both groups, albeit the median follow-up time is different. Acute tolerance profiles were better for IG-IMRT than for 3D-CRT. Our preliminary results support the clinical safety and efficacy of advanced RT planning and delivery techniques in patients affected with early stage HL, achieving complete response after ABVD-based chemotherapy.

Original languageEnglish
Pages (from-to)370-375
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume89
Issue number2
DOIs
Publication statusPublished - Jun 1 2014

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Hodgkin Disease
radiation therapy
Radiotherapy
Dacarbazine
Vinblastine
Bleomycin
toxicity
Doxorubicin
Recurrence
chemotherapy
dosage
Survival
grade
mediastinum
Planning Techniques
Radiation
Drug Therapy
Mucositis
Mediastinum
radiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research
  • Radiation

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Involved-site image-guided intensity modulated versus 3d conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma. / Filippi, Andrea Riccardo; Ciammella, Patrizia; Piva, Cristina; Ragona, Riccardo; Botto, Barbara; Gavarotti, Paolo; Merli, Francesco; Vitolo, Umberto; Iotti, Cinzia; Ricardi, Umberto.

In: International Journal of Radiation Oncology Biology Physics, Vol. 89, No. 2, 01.06.2014, p. 370-375.

Research output: Contribution to journalArticle

Filippi, Andrea Riccardo ; Ciammella, Patrizia ; Piva, Cristina ; Ragona, Riccardo ; Botto, Barbara ; Gavarotti, Paolo ; Merli, Francesco ; Vitolo, Umberto ; Iotti, Cinzia ; Ricardi, Umberto. / Involved-site image-guided intensity modulated versus 3d conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 89, No. 2. pp. 370-375.
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abstract = "Purpose Image-guided intensity modulated radiation therapy (IG-IMRT) allows for margin reduction and highly conformal dose distribution, with consistent advantages in sparing of normal tissues. The purpose of this retrospective study was to compare involved-site IG-IMRT with involved-site 3D conformal RT (3D-CRT) in the treatment of early stage Hodgkin lymphoma (HL) involving the mediastinum, with efficacy and toxicity as primary clinical endpoints. Methods and Materials We analyzed 90 stage IIA HL patients treated with either involved-site 3D-CRT or IG-IMRT between 2005 and 2012 in 2 different institutions. Inclusion criteria were favorable or unfavorable disease (according to European Organization for Research and Treatment of Cancer criteria), complete response after 3 to 4 cycles of an adriamycin- bleomycin-vinblastine-dacarbazine (ABVD) regimen plus 30 Gy as total radiation dose. Exclusion criteria were chemotherapy other than ABVD, partial response after ABVD, total radiation dose other than 30 Gy. Clinical endpoints were relapse-free survival (RFS) and acute toxicity. Results Forty-nine patients were treated with 3D-CRT (54.4{\%}) and 41 with IG-IMRT (45.6{\%}). Median follow-up time was 54.2 months for 3D-CRT and 24.1 months for IG-IMRT. No differences in RFS were observed between the 2 groups, with 1 relapse each. Three-year RFS was 98.7{\%} for 3D-CRT and 100{\%} for IG-IMRT. Grade 2 toxicity events, mainly mucositis, were recorded in 32.7{\%} of 3D-CRT patients (16 of 49) and in 9.8{\%} of IG-IMRT patients (4 of 41). IG-IMRT was significantly associated with a lower incidence of grade 2 acute toxicity (P=.043). Conclusions RFS rates at 3 years were extremely high in both groups, albeit the median follow-up time is different. Acute tolerance profiles were better for IG-IMRT than for 3D-CRT. Our preliminary results support the clinical safety and efficacy of advanced RT planning and delivery techniques in patients affected with early stage HL, achieving complete response after ABVD-based chemotherapy.",
author = "Filippi, {Andrea Riccardo} and Patrizia Ciammella and Cristina Piva and Riccardo Ragona and Barbara Botto and Paolo Gavarotti and Francesco Merli and Umberto Vitolo and Cinzia Iotti and Umberto Ricardi",
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T1 - Involved-site image-guided intensity modulated versus 3d conformal radiation therapy in early stage supradiaphragmatic Hodgkin lymphoma

AU - Filippi, Andrea Riccardo

AU - Ciammella, Patrizia

AU - Piva, Cristina

AU - Ragona, Riccardo

AU - Botto, Barbara

AU - Gavarotti, Paolo

AU - Merli, Francesco

AU - Vitolo, Umberto

AU - Iotti, Cinzia

AU - Ricardi, Umberto

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Purpose Image-guided intensity modulated radiation therapy (IG-IMRT) allows for margin reduction and highly conformal dose distribution, with consistent advantages in sparing of normal tissues. The purpose of this retrospective study was to compare involved-site IG-IMRT with involved-site 3D conformal RT (3D-CRT) in the treatment of early stage Hodgkin lymphoma (HL) involving the mediastinum, with efficacy and toxicity as primary clinical endpoints. Methods and Materials We analyzed 90 stage IIA HL patients treated with either involved-site 3D-CRT or IG-IMRT between 2005 and 2012 in 2 different institutions. Inclusion criteria were favorable or unfavorable disease (according to European Organization for Research and Treatment of Cancer criteria), complete response after 3 to 4 cycles of an adriamycin- bleomycin-vinblastine-dacarbazine (ABVD) regimen plus 30 Gy as total radiation dose. Exclusion criteria were chemotherapy other than ABVD, partial response after ABVD, total radiation dose other than 30 Gy. Clinical endpoints were relapse-free survival (RFS) and acute toxicity. Results Forty-nine patients were treated with 3D-CRT (54.4%) and 41 with IG-IMRT (45.6%). Median follow-up time was 54.2 months for 3D-CRT and 24.1 months for IG-IMRT. No differences in RFS were observed between the 2 groups, with 1 relapse each. Three-year RFS was 98.7% for 3D-CRT and 100% for IG-IMRT. Grade 2 toxicity events, mainly mucositis, were recorded in 32.7% of 3D-CRT patients (16 of 49) and in 9.8% of IG-IMRT patients (4 of 41). IG-IMRT was significantly associated with a lower incidence of grade 2 acute toxicity (P=.043). Conclusions RFS rates at 3 years were extremely high in both groups, albeit the median follow-up time is different. Acute tolerance profiles were better for IG-IMRT than for 3D-CRT. Our preliminary results support the clinical safety and efficacy of advanced RT planning and delivery techniques in patients affected with early stage HL, achieving complete response after ABVD-based chemotherapy.

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