Boros A, Ribrag V, Deutsch É, Chargari C, Izar F
Département de radiothérapie, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Université Paris Sud, université Paris Saclay, 94270 Le Kremlin-Bicêtre, France.
Département d'hématologie, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Département des innovations thérapeutiques et essais précoces, Cancer campus Grand-Paris, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
Cancer Radiother. 2018 Sep;22(5):404-410. doi: 10.1016/j.canrad.2018.07.007. Epub 2018 Jul 31.
The optimization of radiotherapy in these young and long-lived survivors raises the question about the interest of using modern techniques to allow a better distribution of the dose. The choice of the irradiation technique must take into account the incidence of side effects related to radiation. In this context, the definition of the target volumes as well as the verification and monitoring of the delivered processing are essential. International recommendations for treatment fields are based on the "involved node radiotherapy" concept. The best irradiation technique to use remains to be defined. The use of intensity-modulated radiotherapy improves the coverage and reduces the dose to the organs at risk with a variable gain depending on the topography of the lymph nodes: upper or lower mediastinum, right or left lateralization, the techniques used. The deep inspiration breath-hold technique allows an increase of the pulmonary volume, extension of the mediastinum with an up down of the heart which make possible to move the planning target volume away from the cardiac structures. The volumetric-modulated arctherapy technique with several arches can be particularly interesting to reduce the dose to the breasts, as well as tomotherapy when bulky disease. Proton therapy with the Bragg peak specificity can play a key role in limiting doses to organs at risk, when robust planning that will take into account geometric and physical uncertainties is available. The heterogeneity of Hodgkin lymphomas in terms of volume, shape and initial location are the key elements to take into account when choosing the preferred radiotherapy technique.
在这些年轻且长寿的幸存者中优化放射治疗，引发了关于使用现代技术以实现更好剂量分布的益处的问题。照射技术的选择必须考虑与辐射相关的副作用发生率。在此背景下，靶区体积的定义以及对所实施治疗的验证和监测至关重要。国际上关于治疗野的建议基于“受累淋巴结放疗”概念。最佳使用的照射技术仍有待确定。调强放疗的使用改善了靶区覆盖，并根据淋巴结的位置（上纵隔或下纵隔、右侧或左侧、所使用的技术）以可变的获益程度降低了对危及器官的剂量。深吸气屏气技术可增加肺容积，使纵隔随着心脏上下移动而扩展，从而有可能将计划靶区与心脏结构分开。具有多个弧形的容积调强弧形放疗技术对于降低对乳房的剂量可能特别有意义，当疾病体积较大时，断层放疗也是如此。当具备考虑几何和物理不确定性的稳健计划时，具有布拉格峰特性的质子治疗在限制对危及器官的剂量方面可发挥关键作用。霍奇金淋巴瘤在体积、形状和初始位置方面的异质性是选择首选放射治疗技术时需要考虑的关键因素。
