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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.

journal of medical radiation sciences

A 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