Open AccessA case study evaluating deep inspiration breath‐hold and intensity‐modulated radiotherapy to minimise long‐term toxicity in a young patient with bulky mediastinal Hodgkin lymphoma
Author(s) -
Tomaszewski Jonathan M.,
Crook Sarah,
Wan Kenneth,
Scott Lucille,
Foroudi Farshad
Publication year - 2017
Publication title -
journal of medical radiation sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.484
H-Index - 18
eISSN - 2051-3909
pISSN - 2051-3895
DOI - 10.1002/jmrs.219
Subject(s) - medicine , radiation therapy , radiology , lymphoma , hodgkin lymphoma , stage (stratigraphy) , mediastinum , nuclear medicine , paleontology , biology
Abstract Radiotherapy plays an important role in the treatment of early‐stage Hodgkin lymphoma, but late toxicities such as cardiovascular disease and second malignancy are a major concern. Our aim was to evaluate the potential of deep inspiration breath‐hold ( DIBH ) and intensity‐modulated radiotherapy ( IMRT ) to reduce cardiac dose from mediastinal radiotherapy. A 24 year‐old male with early‐stage bulky mediastinal Hodgkin lymphoma received involved‐site radiotherapy as part of a combined modality programme. Simulation was performed in free breathing ( FB ) and DIBH . The target and organs at risk were contoured on both datasets. Free breathing‐3D conformal ( FB ‐3 DCRT ), DIBH ‐3 DCRT , FB ‐ IMRT and DIBH ‐ IMRT were compared with respect to target coverage and doses to organs at risk. A ‘butterfly’ IMRT technique was used to minimise the low‐dose bath. In our patient, both DIBH (regardless of mode of delivery) and IMRT (in both FB and DIBH ) achieved reductions in mean heart dose. DIBH improved all lung parameters. IMRT reduced high dose (V20), but increased low dose (V5) to lung. DIBH ‐ IMRT was chosen for treatment delivery. Advanced radiotherapy techniques have the potential to further optimise the therapeutic ratio in patients with mediastinal lymphoma. Benefits should be assessed on an individualised basis.