Radiation Oncology Department, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy.
Azienda Ospedaliera San Gerardo, Monza, Italy.
Radiat Oncol. 2020 Mar 12;15(1):62. doi: 10.1186/s13014-020-01504-8.
Advances in therapy have resulted in improved cure rates and an increasing number of long-term Hodgkin's lymphoma (HL) survivors. However, radiotherapy (RT)-related late effects are still a significant issue, particularly for younger patients with mediastinal disease (secondary cancers, heart diseases). In many Centers, technological evolution has substantially changed RT planning and delivery. This consensus document aims to analyze the current knowledge of Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) for mediastinal HL and formulate practical recommendations based on scientific evidence and expert opinions.
A dedicated working group was set up within the Fondazione Italiana Linfomi (FIL) Radiotherapy Committee in May 2018. After a first meeting, the group adopted a dedicated platform to share retrieved articles and other material. Two group coordinators redacted a first document draft, that was further discussed and finalized in two subsequent meetings. Topics of interest were: 1) Published data comparing 3D-conformal radiotherapy (3D-CRT) and IMRT 2) dose objectives for the organs at risk 3) IGRT protocols and motion management.
Data review showed that IMRT might allow for an essential reduction in the high-dose regions for all different thoracic OAR. As very few studies included specific dose constraints for lungs and breasts, the low-dose component for these OAR resulted slightly higher with IMRT vs. 3D-CRT, depending on the technique used. We propose a set of dose objectives for the heart, breasts, lungs, and thyroid. The use of IGRT is advised for margin reduction without specific indications, such as the use of breath-holding techniques. An individual approach, including comparative planning and considering different risk factors for late morbidity, is recommended for each patient.
As HL therapy continues to evolve, with an emphasis on treatment reduction, radiation oncologists should use at best all the available tools to minimize the dose to organs at risk and optimize treatment plans. This document provides indications on the use of IMRT/IGRT based on expert consensus, providing a basis for clinical implementation and future development.
治疗的进步提高了治愈率，并使越来越多的霍奇金淋巴瘤（HL）长期幸存者增加。然而，放射治疗（RT）相关的晚期效应仍然是一个重大问题，尤其是对于纵隔疾病（继发性癌症，心脏病）的年轻患者。在许多中心，技术的发展极大地改变了 RT 计划和实施。本共识文件旨在分析适形调强放疗（IMRT）和图像引导放疗（IGRT）在纵隔 HL 中的应用现状，并基于科学证据和专家意见制定实用建议。
2018 年 5 月，意大利淋巴瘤基金会（FIL）放射治疗委员会成立了一个专门的工作组。在第一次会议之后，该小组采用了一个专用平台来共享检索到的文章和其他材料。两名小组协调员起草了第一份文件草案，然后在随后的两次会议上进一步讨论和定稿。感兴趣的主题包括：1）比较 3D 适形放疗（3D-CRT）和 IMRT 的已发表数据；2）危及器官的剂量目标；3）IGRT 方案和运动管理。
数据审查表明，IMRT 可能会使所有不同的胸部 OAR 的高剂量区域明显减少。由于很少有研究为肺和乳房规定了特定的剂量限制，因此与 3D-CRT 相比，IMRT 对这些 OAR 的低剂量成分略高，这取决于所使用的技术。我们提出了一套针对心脏，乳房，肺和甲状腺的剂量目标。建议在没有特定指示（例如使用屏气技术）的情况下使用 IGRT 以减少边缘，例如使用屏气技术。建议对每个患者采用个体化方法，包括比较计划并考虑晚期发病的不同危险因素。
随着 HL 治疗的不断发展，重点是减少治疗，放射肿瘤学家应尽可能利用所有可用工具将危及器官的剂量降至最低，并优化治疗计划。本文档基于专家共识提供了有关 IMRT/IGRT 使用的说明，为临床实施和未来发展提供了基础。
