6002 ORAL Involved-field radiotherapy (IFRT) and involved-nodal radiotherapy (INRT) as a component of combination therapy for limited stage Hodgkin lymphoma: a question of field size

2007 ◽  
Vol 5 (4) ◽  
pp. 345-346
Author(s):  
B. Campbell ◽  
N. Voss ◽  
T. Pickles ◽  
J. Morris ◽  
J.M. Connors
Keyword(s):  
Combination Therapy ◽  
Hodgkin Lymphoma ◽  
Field Size ◽  
Limited Stage ◽  
Involved Field ◽  
Involved Field Radiotherapy

Successful treatment of non-Hodgkin lymphoma associated immune thrombocytopenia with involved field radiotherapy

2013 ◽  
Vol 31 (4) ◽  
pp. 218-220 ◽  
Author(s):  
Tanya Berrang ◽  
Caroline Holloway ◽  
Jason Hart ◽  
Adrian Yee ◽  
Brian Berry ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Successful Treatment ◽  
Immune Thrombocytopenia ◽  
Non Hodgkin Lymphoma ◽  
Involved Field ◽  
Involved Field Radiotherapy

Limited-Stage Disease: Optimal Use of Chemotherapy and Radiation Treatment

Hematology ◽  
2008 ◽  
Vol 2008 (1) ◽  
pp. 321-325 ◽  
Author(s):  
John Radford
Keyword(s):  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Late Toxicity ◽  
Standard Of Care ◽  
Early Years ◽  
Wide Field ◽  
Current Standard ◽  
Limited Stage ◽  
Stage Disease ◽  
Involved Field

AbstractIn the early years of treatment for limited-stage Hodgkin lymphoma there was an understandable focus on disease elimination. This has been replaced by concerns about the amount and balance of different therapies and eventually, as cure rates improve, a desire to individualize management based on risk factors at presentation and response to initial treatment. In limited stage Hodgkin lymphoma, early success was obtained with wide field radiotherapy but later combined modality approaches were employed to overcome the problem of out of field radiotherapy relapses. The acute and delayed toxicity of alkylating agent based therapies led to their replacement with ABVD and concerns about the late toxicity of radiotherapy resulted in smaller field sizes being first assessed in clinical trial and later introduced into clinical practice. The current standard of care of 3 or 4 cycles of ABVD followed by involved-field radiotherapy in clinically staged patients is the culmination of years of work involving many thousands of patients taking part in clinical trials.Our current focus is on the role of PET imaging and whether a response-adapted approach guided by PET can individualize therapy such that radiotherapy and its attendant late toxicity that impacts on future quality of life and survival can be avoided altogether in a subset of patients.

scholarly journals Predicted Risks of Cardiovascular Disease Following Chemotherapy and Radiotherapy in the UK NCRI RAPID Trial of Positron Emission Tomography–Directed Therapy for Early-Stage Hodgkin Lymphoma

2021 ◽  
pp. JCO.21.00408
Author(s):  
David J. Cutter ◽  
Johanna Ramroth ◽  
Patricia Diez ◽  
Andy Buckle ◽  
Georgios Ntentas ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Positron Emission Tomography ◽  
Cardiovascular Risk ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Emission Tomography ◽  
Positron Emission ◽  
Increased Risk ◽  
Involved Field ◽  
Involved Field Radiotherapy

PURPOSE The contemporary management of early-stage Hodgkin lymphoma (ES-HL) involves balancing the risk of late adverse effects of radiotherapy against the increased risk of relapse if radiotherapy is omitted. This study provides information on the risk of radiation-related cardiovascular disease to help personalize the delivery of radiotherapy in ES-HL. METHODS We predicted 30-year absolute cardiovascular risk from chemotherapy and involved field radiotherapy in patients who were positron emission tomography (PET)–negative following three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy within a UK randomized trial of PET-directed therapy for ES-HL. Cardiac and carotid radiation doses and chemotherapy exposure were combined with established dose-response relationships and population-based mortality and incidence rates. RESULTS Average mean heart dose was 4.0 Gy (range 0.1-24.0 Gy) and average bilateral common carotid artery dose was 21.5 Gy (range 0.6-38.1 Gy), based on individualized cardiovascular dosimetry for 144 PET-negative patients receiving involved field radiotherapy. The average predicted 30-year radiation-related absolute excess overall cardiovascular mortality was 0.56% (range 0.01%-6.79%; < 0.5% in 67% of patients and > 1% in 15%), whereas average predicted 30-year excess incidence was 6.24% (range 0.31%-31.09%; < 5% in 58% of patients and > 10% in 24%). For cardiac disease, the average predicted 30-year radiation-related absolute excess mortality was 0.42% (0.79% with mediastinal involvement and 0.05% without) and for stroke, it was 0.14%. CONCLUSION Predicted excess cardiovascular risk is small for most patients, so radiotherapy may provide net benefit. However, for a minority of patients receiving high doses of radiation to cardiovascular structures, it may be preferable to consider advanced radiotherapy techniques to reduce doses or to omit radiotherapy and accept the increased relapse risk. Individual assessment of cardiovascular and other risks before treatment would allow personalized decision making about radiotherapy in ES-HL.

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