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Can treatment of pediatric Hodgkin's lymphoma be improved by PET imaging and proton therapy?

Can treatment of pediatric Hodgkin's lymphoma be improved by PET imaging and proton therapy?

Strahlentherapie und Onkologie 189(1): 54-61

To explore a new positron emission tomography (PET)-based target concept for pediatric Hodgkin s lymphoma (PHL).For 10 patients, the planning target volume PTV1 was based on initial CT tumor extension and PTV2 on anatomy-related PET-positive lymph node levels after chemotherapy. The treatment techniques investigated (prescribed dose 19.8 Gy) comprised opposed-field (2F), intensity-modulated photon (IMXT), and single-field (PS) proton techniques. Treatment concepts were compared concerning dose-volume histogram (DVH) parameters and organ-equivalent doses (OED).The median PTV1 and PTV2 were 902? ?555 cm3 and 281? ?228 cm3. When using PTV2 instead of PTV1 for all techniques, the D2% of the heart was reduced from 14 to 9 Gy and the Dmean of the thyroid from 16.6 to 2.7 Gy. Low- (20%), median- (50%), and high-dose volumes (80%) were reduced by 60% for the heart and bones using PTV2. PS reduced the high-dose volume of the lungs and the heart by up to 60%. IMXT increased the low-dose volumes and OED. PTV2 reduced OED by 54? ?10% for all organs at risk.PTV2 has a high impact on the treated volume and on sparing of organs at risk. The combination of an adaptive target volume definition with protons could contribute to future PHL treatment concepts.

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Accession: 036697788

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PMID: 23161118

DOI: 10.1007/s00066-012-0235-8

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