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Involved-Node-Radiotherapie in frühen Stadien des Hodgkin-Lymphoms

Involved-node radiotherapy in early-stage Hodgkin’s lymphoma

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Zusammenfassung

Die Strahlenbehandlung des Hodgkin-Lymphoms erfuhr eine Entwicklung von der Extended-Field- zur Involved-Field- (IF-)Radiotherapie bei anhaltend hohen Heilungsraten. Kürzlich erschienene Publikationen empfehlen die weitere Reduktion der Bestrahlungsvolumina hin zur Involved-Node- (IN-)Radiotherapie. Allerdings ist dieses Vorgehen bislang nicht innerhalb randomisierter klinischer Studien geprüft worden. Daher wird die Deutsche Hodgkin Studiengruppe in der zukünftigen HD17-Studie die IF- mit der IN-Radiotherapie vergleichen. Das klinische Zielvolumen (CTV, „clinical target volume“) umfasst die initial als befallen gewerteten Lymphknoten. Es berücksichtigt die initiale Ausdehnung der Erkrankung inklusive der Verlagerung von Normalgeweben. Der Sicherheitssaum des Planungszielvolumens (PTV, „planning target volume“) sollte in axialer Ausdehnung 2 cm, in kraniokaudaler Ausrichtung 3 cm betragen. Um die Lungentoxizität und kardiale Toxizität gering zu halten, wird im Mediastinum ein anderes Vorgehen empfohlen. Das Konzept der IN-Radiotherapie soll das Auftreten radiogener Toxizitäten, inklusive Zweitneoplasien, weiter minimieren. Die Feldgrößen werden im Vergleich zur IF-Radiotherapie weiter abnehmen.

Abstract

Radiotherapy of Hodgkin’s lymphoma has evolved from extended-field to involved-field (IF) radiotherapy which reduces toxicity whilst maintaining high rates of healing. Recent publications recommend further reduction of the radiation field to involved-node (IN) radiotherapy; however, this concept has never been tested in a randomized trial. The German Hodgkin Study Group (GHSG) aims to compare IN with standard IF radiotherapy in the future HD17 trial.

The clinical target volume (CTV) encompasses the initial volume of the lymph node(s) before chemotherapy and incorporates the initial location and extent of the disease, taking into account the displacement of the normal tissues. The margin of the planning target volume (PTV) should be 2 cm in the axial and 3 cm in the craniocaudal direction. To minimize lung and cardiac toxicity the target definition in the mediastinum is different. The concept of IN radiotherapy has been proposed as a means to further improve the therapeutic ratio by reducing the risk of radiation-induced toxicity, including second malignancies. Field sizes will further decrease compared to IF radiotherapy.

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  1. Klinik und Poliklinik für Strahlentherapie, Klinikum der Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    H.T. Eich, C. Zimmermann & R.-P. Müller

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  1. H.T. Eich
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  2. C. Zimmermann
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  3. R.-P. Müller
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Correspondence to H.T. Eich.

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Eich, H., Zimmermann, C. & Müller, RP. Involved-Node-Radiotherapie in frühen Stadien des Hodgkin-Lymphoms. Onkologe 16, 35–40 (2010). https://doi.org/10.1007/s00761-009-1768-z

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