Modern radiation therapy for hodgkin lymphom-target definition and dose guidelines from the international lymphoma radiation oncology group
Lena Specht,MD,PhD1,Joachim Yahalom,MD2,Tim Illidge,MD,PhD3,Anne Kiil Berthelsen,MD4,Louis S.Constine,MD5,Hans Theodor Eich,MD,PhD6,Theodore Girinsky,MD7,Richard T.Hoppe,MD8,Peter Mauch,MD9,N.George Mikhaeel,MD10,Andrea Ng,MD,MPH9
1Institute of Cancer Sciences,University of Manchester,Manchester Academic Health Sciences Centre,The Christie National Health Service Foundation Trust,Manchester,United Kingdom;2Department of Oncology and Hematology,Rigshospitalet,University of Copenhagen,Copenhagen,Denmark;3Department of Radiation Oncology,Memorial Sloan-Kettering Cancer Center,New York,New York;4Department of Radiotherapy,The Netherlands Cancer Institute,Amsterdam,The Netherlands;5Department of Radiation Oncology and PET Centre,Rigshospitalet,University of Copenhagen,Copenhagen,Denmark;6Departments of Radiation Oncology and Pediatrics,James P.Wilmot Cancer Center,University of Rochester Medical Center,Rochester,New York;7Division of Radiation Oncology,Department of Radiation Oncology,The University of Texas MD Anderson Cancer Center,Houston,Texas;8Department of Radiation Oncology,Brigham and Women’s Hospital and Dana-Farber Cancer Institute,Harvard University,Boston,Massachusetts;9Radiation Oncology Unit,Department of Oncology,University of Torino,Torino,Italy;and 10Division of Radiation Oncology,Peter MacCallum Cancer Institute,St. Andrews Place,East Melbourne,AustraliaWu Tao,Liu Weixin,Qi Shunang,li Yexiong,translationDepartment of Lymphoma,Guizhou Tumor Hospital,Department of Oncology,Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China (Wu T);Department of Radiation Oncology,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021,China (Liu WX,Qi SN,Li YX)
Abstract： Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced volumes and doses is addressed, integrating modern imaging with 3-dimensional (3D) planning and advanced techniques of treatment delivery. The previously applied extended field (EF) and original involved field (IF) techniques, which treated larger volumes based on nodal stations, have now been replaced by the use of limited volumes, based solely on detectable nodal (and extranodal extension) involvement at presentation, using contrast-enhanced computed tomography, positron emission tomography/computed tomography, magnetic resonance imaging, or a combination of these techniques. The International Commission on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom optimal imaging is available, is explained. A new concept, involved site radiation therapy (ISRT), is introduced as the standard conformal therapy for the scenario, commonly encountered, wherein optimal imaging is not available. There is increasing evidence that RT doses used in the past are higher than necessary for disease control in this era of combined modality therapy. The use of INRT and of lower doses in early-stage HL is supported by available data. Although the use of ISRT has not yet been validated in a formal study, it is more conservative than INRT, accounting for suboptimal information and appropriately designed for safe local disease control. The goal of modern smaller field radiation therapy is to reduce both treatment volume and treatment dose while maintaining efficacy and minimizing acute and late sequelae. This review is a consensus of the International Lymphoma Radiation Oncology Group (ILROG) Steering Committee regarding the modern approach to RT in the treatment of HL, outlining a new concept of ISRT in which reduced treatment volumes are planned for the effective control of involved sites of HL.
. Modern radiation therapy for hodgkin lymphom-target definition and dose guidelines from the international lymphoma radiation oncology group[J]. Chinese Journal of Radiation Oncology, 2017, 26(10): 1111-1118.
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