Document Type : Original Research
Authors
1 Professor, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 M.Sc., Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Department of Radiation-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
4 Ph.D. Student, Department of Medical Physics and Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5 Ph.D. Student, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
6 Oncologist, Department of Radiation Oncology, Isfahan Milad Hospital, Isfahan, Iran
Abstract
Background: Radiotherapy with large mantle field is an effective technique in increasing the risk of secondary cancers among HL (Hodgkin Lymphoma) patients; therefore, it is essential to choose an effective treatment field including the least medical conditions in radiotherapy.Objective: The present study aimed to plan separate fields for neck and mediastinum using various energies, to compare dose distribution with MLC and to block field formation.Materials and Methods: In this study, 3D conformal treatments, Siemens Oncor accelerator equipped with multi-leaf collimator (MLC) were performed to create anterior-posterior fields. CT-scan data of 18 female patients with neck and mediastinal involvement was imported in TIGRT treatment planning system, and then treatment plans were introduced.Results and Conclusion: Using treatment plan 1, photon 6 MV in neck weighting 1 from interior, 0.5 from posterior, photon 18MV in mediastinum weighting 1 from interior and 0.5 from posterior, it was shown that regarding the common treatment plan used with photon 6 MV, mean dose delivered to breast, lung, esophagus and larynx reduced 6, 7, 41 and 10 percent, respectively and uniformity index improved by 10 percent. Using block compared to MLC in all treatment plans offered improved average dose in all organs under study. To protect breast and lung while using MLC and block in the first treatment plan seemed to be more appropriate; however, using blocks in comparison to MLC increased delivered mean dose in all organs under study. Using separate fields with Pb blocks, though, showed smaller increase.
Keywords
- Villasboas JC, Ansell SM. Recent advances in the management of Hodgkin lymphoma. F1000Res. 2016;5. doi.org/10.12688/f1000research.8301.1. PubMed PMID: 27158471. PubMed PMCID: 4850875.
- Steven H, Swerdlow EC, Harris NL, Jaffe ES, Pireli S, Stein H, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. International agency for research on cancer. Lyon. 2008:274–88.
- Norval EJ, Raubenheimer EJ. Second malignancies in Hodgkin’s disease: A review of the literature and report of a case with a secondary Lennert’s lymphoma. J Oral Maxillofac Pathol. 2014;18:S90-5. doi.org/10.4103/0973-029X.141332. PubMed PMID: 25364188. PubMed PMCID: 4211247.
- Greenfield DM, Wright J, Brown JE, Hancock BW, Davies HA, O’Toole L, et al. High incidence of late effects found in Hodgkin’s lymphoma survivors, following recall for breast cancer screening. Br J Cancer. 2006;94:469-72. doi.org/10.1038/sj.bjc.6602974. PubMed PMID: 16465193. PubMed PMCID: 2361189.
- Glicksman AS, Pajak TF, Gottlieb A, Nissen N, Stutzman L, Cooper MR. Second malignant neoplasms in patients successfully treated for Hodgkin’s disease: a Cancer and Leukemia Group B study. Cancer Treat Rep. 1982;66:1035-44. PubMed PMID: 6951632.
- Koletsky AJ, Bertino JR, Farber LR, Prosnitz LR, Kapp DS, Fischer D, et al. Second neoplasms in patients with Hodgkin’s disease following combined modality therapy--the Yale experience. J Clin Oncol. 1986;4:311-7. doi.org/10.1200/JCO.1986.4.3.311. PubMed PMID: 3950674.
- Arseneau JC, Canellos GP, Johnson R, DeVita VT, Jr. Risk of new cancers in patients with Hodgkin’s disease. Cancer. 1977;40:1912-6. doi.org/10.1002/1097-0142(197710)40:4+3.0.CO;2-D. PubMed PMID: 907993.
- Poston GJ, Beauchamp D, Ruers T. Textbook of surgical oncology: CRC Press; 2007.
- Koh ES, Tran TH, Heydarian M, Sachs RK, Tsang RW, Brenner DJ, et al. A comparison of mantle versus involved-field radiotherapy for Hodgkin’s lymphoma: reduction in normal tissue dose and second cancer risk. Radiat Oncol. 2007;2:13. doi.org/10.1186/1748-717X-2-13. PubMed PMID: 17362522. PubMed PMCID: 1847517.
- Brady LW, Perez CA, Wazer DE. Perez & Brady’s principles and practice of radiation oncology: Lippincott Williams & Wilkins; 2013.
- Halpering E, Perez C, Brady L. Principles and Practice of radiation Oncology. Philadelphia: Lippincott Williams & Wilkins; 2008.
- Bonadonna G, Bonfante V, Viviani S, Di Russo A, Villani F, Valagussa P. ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin’s disease: long-term results. J Clin Oncol. 2004;22:2835-41. doi.org/10.1200/JCO.2004.12.170. PubMed PMID: 15199092.
- Specht L, Ng AK. Background and Rationale for Radiotherapy in Early-Stage Hodgkin Lymphoma. Radiotherapy for Hodgkin Lymphoma: Springer; 2011. p. 7-20.
- Yan G, Liu C, Simon TA, Peng LC, Fox C, Li JG. On the sensitivity of patient-specific IMRT QA to MLC positioning errors. J Appl Clin Med Phys. 2009;10:2915. doi.org/10.1120/jacmp.v10i1.2915. PubMed PMID: 19223841.
- Topolnjak R, van der Heide UA. An analytical approach for optimizing the leaf design of a multi-leaf collimator in a linear accelerator. Phys Med Biol. 2008;53:3007-21. doi.org/10.1088/0031-9155/53/11/017. PubMed PMID: 18490812.
- Cheng CW, Das IJ, Steinberg T. Role of multileaf collimator in replacing shielding blocks in radiation therapy. Int J Cancer. 2001;96:385-95. doi.org/10.1002/ijc.1038. PubMed PMID: 11745510.
- Tajiri M, Sunaoka M, Fukumura A, Endo M. A new radiation shielding block material for radiation therapy. Med Phys. 2004;31:3022-3. doi.org/10.1118/1.1809767. PubMed PMID: 15587655.
- Khan, F.M. and J.P. Gibbons, Khan’s the physics of radiation therapy. Philadelphia, PA: Lippincott Williams & Wilkins; 2014.
- Hoskin P, Díez P, Williams M, Lucraft H, Bayne M. Recommendations for the use of radiotherapy in nodal lymphoma. Clinical Oncology. 2013;25:49-58. doi.org/10.1016/j.clon.2012.07.011.
- De Sanctis V, Bolzan C, D’Arienzo M, Bracci S, Fanelli A, Cox MC, et al. Intensity modulated radiotherapy in early stage Hodgkin lymphoma patients: is it better than three dimensional conformal radiotherapy? Radiat Oncol. 2012;7:129. doi.org/10.1186/1748-717X-7-129. PubMed PMID: 22857015. PubMed PMCID: 3484070.
- Cella L, Liuzzi R, Magliulo M, Conson M, Camera L, Salvatore M, et al. Radiotherapy of large target volumes in Hodgkin’s lymphoma: normal tissue sparing capability of forward IMRT versus conventional techniques. Radiat Oncol. 2010;5:33. doi.org/10.1186/1748-717X-5-33. PubMed PMID: 20459790. PubMed PMCID: 2881006.
- Schill S, Kampfer S, Hansmeier B, Nieder C, Geinitz H, editors. Sparing of critical organs in radiotherapy of mediastinal lymphoma. September 7-12, 2009. Munich, Germany: World Congress on Medical Physics and Biomedical Engineering; 2009.
- Kumar PP, Good RR, Jones EO, Somers JE, McAnulty BE, McCaul GF, et al. Extended-field isocentric irradiation for Hodgkin’s disease. J Natl Med Assoc. 1987;79:969-80. PubMed PMID: 3312619. PubMed PMCID: 2625591.
- Voong KR, McSpadden K, Pinnix CC, Shihadeh F, Reed V, Salehpour MR, et al. Dosimetric advantages of a “butterfly” technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin’s lymphoma. Radiat Oncol. 2014;9:94. doi.org/10.1186/1748-717X-9-94. PubMed PMID: 24735767. PubMed PMCID: 4013438.
- Feuvret L, Noel G, Mazeron JJ, Bey P. Conformity index: a review. Int J Radiat Oncol Biol Phys. 2006;64:333-42. doi.org/10.1016/j.ijrobp.2005.09.028. PubMed PMID: 16414369.
- Tavakolli MB, Maleki M, Akhavan A, Amooheidary A, Abedi E, Hadisinia T. Comparing different treatment plans in radiotherapy of Hodgkin’s disease involving neck and Mediastinum, using “Parallel- opposite fields” method. Journal of Isfahan Medical School. 2017;35:381-6. [in Persian]
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