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Can treatment of pediatric Hodgkin’s lymphoma be improved by PET imaging and proton therapy?

Kann die Behandlung von pädiatrischen Hodgkin-Lymphomen durch PET-Bildgebung und Protonenbestrahlung verbessert werden?

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Abstract

Background and purpose

To explore a new positron emission tomography (PET)-based target concept for pediatric Hodgkin’s lymphoma (PHL).

Patients and methods

For 10 patients, the planning target volume PTV1 was based on initial CT tumor extension and PTV2 on anatomy-related PET-positive lymph node levels after chemotherapy. The treatment techniques investigated (prescribed dose 19.8 Gy) comprised opposed-field (2F), intensity-modulated photon (IMXT), and single-field (PS) proton techniques. Treatment concepts were compared concerning dose-volume histogram (DVH) parameters and organ-equivalent doses (OED).

Results

The median PTV1 and PTV2 were 902 ± 555 cm3 and 281 ± 228 cm3. When using PTV2 instead of PTV1 for all techniques, the D2% of the heart was reduced from 14 to 9 Gy and the Dmean of the thyroid from 16.6 to 2.7 Gy. Low- (20%), median- (50%), and high-dose volumes (80%) were reduced by 60% for the heart and bones using PTV2. PS reduced the high-dose volume of the lungs and the heart by up to 60%. IMXT increased the low-dose volumes and OED. PTV2 reduced OED by 54 ± 10% for all organs at risk.

Conclusion

PTV2 has a high impact on the treated volume and on sparing of organs at risk. The combination of an adaptive target volume definition with protons could contribute to future PHL treatment concepts.

Zusammenfassung

Ziel

Untersuchung einer Positronenemissionstomographie(PET)-basierten Volumendefinition sowie von High-Tech-Bestrahlungstechniken bei pädiatrischen Hodgkin-Lymphomen (PHL).

Patienten und Methode

Für 10 Patienten wurde das Planungsvolumen PTV1 („planning target volume“) auf der initialen CT-basierten Tumorausdehnung und PTV2 auf den anatomischen Bereichen, welche PET-positive Lymphknoten nach Chemotherapie umfassten, bestimmt. Die untersuchten Bestrahlungstechniken (Zieldosis: 19,8 Gy) umfassten 2-Felder-Photonen (2F), intensitätsmodulierte Photonen (IMXT) und Einfelder-Protonen (PS). Behandlungskonzepte bzw. -techniken wurden anhand von Dosis-Volumen-Histogramm (DVH)-Parametern sowie der Organäquivalenzdosis (OED) verglichen.

Ergebnisse

Das mittlere PTV1 bzw. PTV2 betrug 902 ± 555 cm3 und 281 ± 228 cm3. Die Verwendung von PTV2 statt PTV1 reduzierte D2% des Herzens von 14 auf 9 Gy und Dmean der Schilddrüse von 16,6 auf 2,7 Gy für alle Bestrahlungstechniken. Niedrig- (20%), Mittel- (50%) und Hochdosisvolumen (80%) wurden bei Verwendung von PTV2 für Herz und Knochen um 60% reduziert. PS reduzierte das Lungen- bzw. Herz-Hochdosisvolumen um bis zu 60%. IMXT erhöhte das Niedrigdosisvolumen und die OED. PTV2 reduzierte die OED um 54 ± 10% für alle Risikoorgane.

Schlussfolgerung

PTV2 hatte großen Einfluss auf das bestrahlte Volumen und auf die Risikoorganschonung. Eine adaptierte Volumendefinition in Kombination mit Protonentherapie könnte zu zukünftigen PHL-Behandlungskonzepten beitragen.

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Acknowledgments

We thank Uwe Schneider for advice on OED calculations. Financial support by the Austrian Federal Ministry of Economy, Family, and Youth and the Austrian Foundation for Research, Technology, and Development is gratefully acknowledged.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiooncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    B. Knäusl, C. Lütgendorf-Caucig, J. Hopfgartner, K. Dieckmann, R. Pötter & D. Georg

  2. Department of Nuclear Medicine, Medical University of Vienna/AKH Vienna, Vienna, Austria

    B. Knäusl

  3. Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany

    L. Kurch

  4. Department of Radiotherapy, Martin Luther University of Halle-Wittenberg, Halle, Germany

    T. Pelz

  5. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria

    B. Knäusl, K. Dieckmann, R. Pötter & D. Georg

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  1. B. Knäusl
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Correspondence to B. Knäusl.

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Knäusl, B., Lütgendorf-Caucig, C., Hopfgartner, J. et al. Can treatment of pediatric Hodgkin’s lymphoma be improved by PET imaging and proton therapy?. Strahlenther Onkol 189, 54–61 (2013). https://doi.org/10.1007/s00066-012-0235-8

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  • DOI: https://doi.org/10.1007/s00066-012-0235-8

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