Comparison of the Dose Distribution in the Two- and Four-Fields Treatment Plannings with Energy of 6 and 18 Mv in Patients with Hodgkin’s Disease with Mediastinal Involvement

Document Type : Original Article (s)

Authors

1 Professor, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 MSc Student, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department Radiation-Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Radiation Oncologist, Milad Hospital, Isfahan, Iran

5 Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Hodgkin’s disease is a special type of lymphoma or cancer that is associated with the abnormal growth of cells in the lymphatic system. The purpose of this study was to investigate different methods of radiotherapy in women with Hodgkin’s disease who need radiotherapy. Due to the presence of sensitive organs in this area, and secondary disease and cancers after radiotherapy, the importance of reviewing various treatment plans, is outstanding.Methods: The data of computed tomography (CT) scan for 18 women with Hodgkin’s disease with mediastinal involvement were used. In next step, contouring all sensitive organs inside the field and the involved volume was done, using treatment planning system of Seyedoshohada Hospital, Isfahan, Iran. Then, the comparisons between the anterior-posterior/posterior- anterior (AP/PA) common treatment with the energy of 6 and 18 Mv and the four-field techniques with different weights were performed.Findings: The maximum dose reached to the breast was reduced to 33%, compared to the current parallel-opposite technique, in the four- filed technique. On the other hand, the four- filed technique caused an increase of about 2.8 times in the average dose, due to the side-fields. The mean dose reached to the treatment volume was 100-102 percent in the 2-field technique and 99.5 percent in the four-filed technique.Conclusion: For women with Hodgkin’s disease with mediastinal involvement, using the two-field technique with 18 Mv photon weighing 1.5 of anterior and 0.5 of posterior, showed better results compared to the 6 photon. The use of the 4-field technique led to a decrease of V20 value for the whole lung and the average dose received by esophagus and aorta and spinal cord, and V30 value for the heart.

Keywords


  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62(1): 10-29.
  2. Halperin EC, Brady LW, Perez CA, Wazer DE. Perez & Brady's principles and practice of radiation oncology. Philadelphia, PA: Lippincott Williams & Wilkins; 2013.
  3. Aleman BM, van den Belt-Dusebout AW, Klokman WJ, Van't Veer MB, Bartelink H, van Leeuwen FE. Long-term cause-specific mortality of patients treated for Hodgkin's disease. J Clin Oncol 2003; 21(18): 3431-9.
  4. Girinsky T, van der Maazen R, Specht L, Aleman B, Poortmans P, Lievens Y, et al. Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol 2006; 79(3): 270-7.
  5. Ng AK, Bernardo MP, Weller E, Backstrand KH, Silver B, Marcus KC, et al. Long-term survival and competing causes of death in patients with early-stage Hodgkin's disease treated at age 50 or younger. J Clin Oncol 2002; 20(8): 2101-8.
  6. van Leeuwen FE, Klokman WJ, Stovall M, Dahler EC, Van't Veer MB, Noordijk EM, et al. Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin's disease. J Natl Cancer Inst 2003; 95(13): 971-80.
  7. Nihei K, Mitsumori M, Ishigaki T, Fujishiro S, Kokubo M, Nagata Y, et al. Determination of optimal radiation energy for different breast sizes using CT-simulator [correction of simulatior] in tangential breast irradiation. Breast Cancer 2000; 7(3): 231-6.
  8. Yang GY, McClosky SA, Khushalani NI. Principles of modern radiation techniques for esophageal and gastroesophageal junction cancers. Gastrointest Cancer Res 2009; 3(2 Suppl): S6-S10.
  9. Murray L, Sethugavalar B, Robertshaw H, Bayman E, Thomas E, Gilson D, et al. Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks. Clin Oncol (R Coll Radiol) 2015; 27(7): 401-10.
  10. Weber DC, Peguret N, Dipasquale G, Cozzi L. Involved-node and involved-field volumetric modulated arc vs. fixed beam intensity-modulated radiotherapy for female patients with early-stage supra-diaphragmatic Hodgkin lymphoma: a comparative planning study. Int J Radiat Oncol Biol Phys 2009; 75(5): 1578-86.
  11. Cella L, Liuzzi R, Magliulo M, Conson M, Camera L, Salvatore M, et al. Radiotherapy of large target volumes in Hodgkin's lymphoma: normal tissue sparing capability of forward IMRT versus conventional techniques. Radiat Oncol 2010; 5: 33.
  12. Dabaja BS. Comparison of three different mediastinal radiotherapy techniques in female patients: Impact on heart sparing and dose to the breasts. Breast Diseases 2008; 19(3): 264.
  13. Feuvret L, Noel G, Mazeron JJ, Bey P. Conformity index: a review. Int J Radiat Oncol Biol Phys 2006; 64(2): 333-42.
  14. Voong KR, McSpadden K, Pinnix CC, Shihadeh F, Reed V, Salehpour MR, et al. Dosimetric advantages of a "butterfly" technique for intensity-modulated radiation therapy for young female patients with mediastinal Hodgkin's lymphoma. Radiat Oncol 2014; 9: 94.
  15. Vaezzadeh SA, Allahverdi M, Nedaie H, Aghili M, Esfehani M, Mohammadi E. Dosimetric comparison of various radiotherapeutic treatment plans using cobalt-60 and linac for prostate cancer. Iran J Med Phys 2009; 6(2): 71-9. [In Persian].
  16. Hoskin PJ, Diez P, Williams M, Lucraft H, Bayne M. Recommendations for the use of radiotherapy in nodal lymphoma. Clin Oncol (R Coll Radiol) 2013; 25(1): 49-58.
  17. Nieder C, Schill S, Kneschaurek P, Molls M. Comparison of three different mediastinal radiotherapy techniques in female patients: Impact on heart sparing and dose to the breasts. Radiother Oncol 2007; 82(3): 301-7.