Radiation therapy planning for early-stage Hodgkin lymphoma: experience of the International Lymphoma Radiation Oncology Group

Maja V Maraldo, Bouthaina S Dabaja, Andrea R Filippi, Tim Illidge, Richard Tsang, Umberto Ricardi, Peter M Petersen, Deborah A Schut, John Garcia, Jayne Headley, Amy Parent, Benoit Guibord, Riccardo Ragona, Lena Specht

    16 Citations (Scopus)


    PURPOSE: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs).

    METHODS: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013.

    RESULTS: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient.

    CONCLUSIONS: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs.

    Original languageEnglish
    JournalInternational Journal of Radiation: Oncology - Biology - Physics
    Issue number1
    Pages (from-to)144-52
    Number of pages9
    Publication statusPublished - 1 May 2015


    • Adult
    • Aged
    • Axilla
    • Breast
    • Cancer Care Facilities
    • Female
    • Head and Neck Neoplasms
    • Heart
    • Hodgkin Disease
    • Humans
    • Lung
    • Male
    • Mediastinal Neoplasms
    • Middle Aged
    • Organs at Risk
    • Radiation Oncology
    • Radiotherapy Dosage
    • Radiotherapy Planning, Computer-Assisted
    • Radiotherapy, Conformal
    • Radiotherapy, Intensity-Modulated
    • Thyroid Gland
    • Young Adult


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