Hodgkin’s Lymphoma in Young Female Patients Can be Safely Treated with Radiation: A New Technique...
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Hodgkin’s Lymphoma in Young Female Patients Can be Safely Treated with Radiation: A New Technique That Avoids The Breasts And Decrease The Heart Dose. Dabaja B, M.D., Rebueno N C.S BS, CMD, Thorne S B.S,CMD, Tolani N, MS, Das P, M.D, Younes A, M.D., Fanale M, M.D., Delclos M, M.D., Iyengar P, M.D., Ph.D., Reed V M.D., and Salehpour MR Ph.D. Introduction Young females with Hodgkin’s Lymphoma pose a challenge to radiation oncologists when treating the disease in the chest with involved field. A new technique is developed to overcome this problem. Purpose: To demonstrate how this new technique can help to reduce the dose to the breasts in heart in most young female patients. Results Methods An inclined board (IB) was constructed with the ability to mount the following: an aquaplast mask, a Vacu-Loc immobilization bag, and a hip stopper. Indexing this device to the couch ensures daily set-up and reproducibility (see Image below). Acquisition of the CT slices span from the level of the vertex to below the diaphragm. Treatment planning is performed using a 90º table angle and 15º gantry rotation to compensate for the beam divergence resulting from the patient position on the IB. This setup moves the breasts and heart further from the treatment field. Additionally, it allows for similar mandible and lung sparing as compared to conventional technique. Conclusions:: In contrast to conventional methods, this simple device and technique allows for the avoidance of breasts and decrease in heart dose while maintaining comparable target coverage and total lung dose in most young female patients. Heart moves away from the field of XRT when on the IB IB avoids breasts Patient’s set up Eight female patients diagnosed with Hodgkin’s lymphoma, treated to complete remission with chemotherapy were planned with and without the IB. The dose planned was 30.6 Gy. Age ranged between 20 and 30 years. Dose volume histogram was generated for right and left breast, Heart, and lung . •The mean value of V30 of the right breast of all eight patients was zero on IB, compared to a mean value of V30 of 3% without IB (range 0 to 16%). •The mean value of V5 of the right breast of all patients decreased from 6% (range 1-17%) to 2% (range 1-5%) using IB. •The mean value of V30 of the left breast of all patients decreased from 3% (range 0-7 %) to 0.4% (range 0-3) using IB. •The mean value of V5 of the left breast of all patients decreased from 13 % (range 1-26%) to 8% (range 2-16%) using IB. Breasts in the field of radiation when in a flat position •The heart moved caudally in all patients which resulted in a better sparing reflected by a decrease in the mean value of V5 of all patients from 36% (range 7-86%) to 29 % (range 0-68%) by using the IB. The mean value of V30 of all patients decreased from 13% (range 0-25 %) to 5% (0-53%). •The total lung volume and the target coverage were similar in both techniques. Results R breast- V5 R breastV30 L breast V5 L breast V30 Heart V5 Heart V30 IB 2% 0% 8% 0.4% 29% 5% Without IB 6% 3% 13% 3% 36% 13% %reduction using IB 66% 100% 39% 87% 20% 62%
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Transcript of Hodgkin’s Lymphoma in Young Female Patients Can be Safely Treated with Radiation: A New Technique...
Hodgkin’s Lymphoma in Young Female Patients Can be Safely Treated with Radiation: A New Technique That Avoids The Breasts And Decrease The Heart Dose.
Dabaja B, M.D., Rebueno N C.S BS, CMD, Thorne S B.S,CMD, Tolani N, MS, Das P, M.D, Younes A, M.D., Fanale M, M.D., Delclos M, M.D., Iyengar P, M.D., Ph.D., Reed V M.D., and Salehpour MR Ph.D.
IntroductionYoung females with Hodgkin’s Lymphoma pose a challenge to radiation oncologists when treating the disease in the chest with involved field. A new technique is developed to overcome this problem.
Purpose: To demonstrate how this new technique can help to reduce the dose to the breasts in heart in most young female patients.
Results
MethodsAn inclined board (IB) was constructed with the ability to mount the following: an aquaplast mask, a Vacu-Loc immobilization bag, and a hip stopper. Indexing this device to the couch ensures daily set-up and reproducibility (see Image below). Acquisition of the CT slices span from the level of the vertex to below the diaphragm. Treatment planning is performed using a 90º table angle and 15º gantry rotation to compensate for the beam divergence resulting from the patient position on the IB. This setup moves the breasts and heart further from the treatment field. Additionally, it allows for similar mandible and lung sparing as compared to conventional technique.
Conclusions:: In contrast to conventional methods, this simple device and technique allows for the avoidance of breasts and decrease in heart dose while maintaining comparable target coverage and total lung dose in most young female patients.
Heart moves away from the field of XRT when on the IB
IB avoids breasts
Patient’s set up
Eight female patients diagnosed with Hodgkin’s lymphoma, treated to complete
remission with chemotherapy were planned with and without the IB.
The dose planned was 30.6 Gy. Age ranged between 20 and 30 years.
Dose volume histogram was generated for right and left breast, Heart, and lung.
•The mean value of V30 of the right breast of all eight patients was zero on IB,
compared to a mean value of V30 of 3% without IB (range 0 to 16%).
•The mean value of V5 of the right breast of all patients decreased from 6% (range 1-
17%) to 2% (range 1-5%) using IB. •The mean value of V30 of the left breast of all patients decreased from 3% (range 0-7 %) to
0.4% (range 0-3) using IB. •The mean value of V5 of the left breast of all
patients decreased from 13 % (range 1-26%) to 8% (range 2-16%) using IB.
Breasts in the field of radiation when in a flat position
•The heart moved caudally in all patients which resulted in a better sparing reflected by a decrease in the mean value of V5 of all patients from 36% (range 7-86%) to 29 % (range 0-68%) by using the IB. The mean value of V30 of all patients decreased from 13% (range 0-25 %) to 5% (0-53%).
•The total lung volume and the target coverage were similar in both techniques.
Results R breast-V5
R breastV30 L breast V5 L breast V30 Heart V5 Heart V30
IB 2% 0% 8% 0.4% 29% 5%Without IB 6% 3% 13% 3% 36% 13%%reduction using IB
66% 100% 39% 87% 20% 62%
