Department of Radiation Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Strahlenther Onkol. 2021 Jan;197(1):56-62. doi: 10.1007/s00066-020-01682-0. Epub 2020 Sep 18.
Mediastinal radiotherapy (RT), especially when combined with bleomycin, may result in substantial pulmonary morbidity and mortality. The use of modern RT techniques like intensity-modulated radiotherapy (IMRT) is gaining interest to spare organs at risk.
We evaluated 27 patients who underwent RT for Hodgkin's lymphoma between 2009 and 2013 at our institution. For each patient, three different treatment plans for a 30-Gy involved-field RT (IFRT) were created (anterior-posterior-posterior-anterior setup [APPA], 5‑field IMRT, and 7‑field IMRT) and analyzed concerning their inherent "normal tissue complication probability" (NTCP) for pneumonitis and secondary pulmonary malignancy.
The comparison of different radiation techniques showed a significant difference in favor of standard APPA (p < 0.01). The risk of lung toxicity was significantly higher in plans using 7‑field IMRT than in plans using 5‑field IMRT. The absolute juxtaposition showed an increase in risk for radiation pneumonitis of 1% for plans using 5‑field IMRT over APPA according to QUANTEC (Quantitative Analyses of Normal Tissue Effects in the Clinic) parameters (Burman: 0.15%) and 2.6% when using 7‑field IMRT over APPA (Burman: 0.7%) as well as 1.6% when using 7‑field IMRT over 5‑field IMRT (Burman: 0.6%). Further analysis showed an increase in risk for secondary pulmonary malignancies to be statistically significant (p < 0.01); mean induction probability for pulmonary malignoma was 0.1% higher in plans using 5‑field IMRT than APPA and 0.19% higher in plans using 7‑field IMRT than APPA as well as 0.09% higher in plans using 7‑field IMRT than 5‑field IMRT. During a median follow-up period of 65 months (95% confidence interval: 53.8-76.2 months), only one patient developed radiation-induced pneumonitis. No secondary pulmonary malignancies have been detected to date.
Radiation-induced lung toxicity is rare after treatment for Hodgkin lymphoma but may be influenced significantly by the RT technique used. In this study, APPA RT plans demonstrated a decrease in potential radiation pneumonitis and pulmonary malignancies. Biological planning using NTCP may have the potential to define personalized RT strategies.
纵隔放射治疗（RT），特别是联合博来霉素治疗，可能导致严重的肺部发病率和死亡率。使用调强放射治疗（IMRT）等现代 RT 技术来保护危险器官的兴趣正在增加。
我们评估了 2009 年至 2013 年间在我们机构接受霍奇金淋巴瘤 RT 治疗的 27 名患者。对于每个患者，我们创建了三种不同的 30Gy 累及野 RT（IFRT）治疗计划（前后前后设置[APPA]、5 野 IMRT 和 7 野 IMRT），并分析了它们对放射性肺炎和继发性肺恶性肿瘤的固有“正常组织并发症概率”（NTCP）的影响。
不同放射技术的比较显示，标准 APPA 具有显著优势（p<0.01）。7 野 IMRT 计划的肺毒性风险明显高于 5 野 IMRT 计划。根据 QUANTEC（临床正常组织效应的定量分析）参数，绝对并置显示 5 野 IMRT 计划相对于 APPA 增加放射性肺炎风险 1%（Burman：0.15%），7 野 IMRT 计划相对于 APPA 增加 2.6%（Burman：0.7%），7 野 IMRT 计划相对于 5 野 IMRT 计划增加 1.6%（Burman：0.6%）。进一步分析显示，继发性肺恶性肿瘤的风险增加具有统计学意义（p<0.01）；5 野 IMRT 计划的肺恶性肿瘤发生率比 APPA 高 0.1%，7 野 IMRT 计划的肺恶性肿瘤发生率比 APPA 高 0.19%，7 野 IMRT 计划的肺恶性肿瘤发生率比 5 野 IMRT 计划高 0.09%。在中位随访期 65 个月（95%置信区间：53.8-76.2 个月）期间，只有 1 名患者发生放射性肺炎。迄今为止，尚未发现继发性肺恶性肿瘤。
霍奇金淋巴瘤治疗后发生放射性肺毒性的情况很少见，但可能会受到所使用的 RT 技术的显著影响。在这项研究中，APPA RT 计划显示出潜在放射性肺炎和肺恶性肿瘤的发生率降低。使用 NTCP 的生物学计划有可能定义个性化的 RT 策略。
