radiotherapy

Conventional and Conformal Radiotherapy with and without Beam Intensity Modulation in Patients with Stage II Hodgkin’s Lymphoma with Supradiaphragmal Lesions

LYMPHOID TUMORS , , ,

YuN Vinogradova1, EI Ivanova1, AI Chumachenko1, EV Smirnova2, GI Andreev2, AM Kalesnik2, NA Vorob’ev2, NV Il’in1

1 AM Granov Russian Research Centre of Radiology and Surgery Technologies, 70 Leningradskaya str., Pesochnyi, Saint Petersburg, Russian Federation, 197758

2 Nuclear Medicine Centre of SM Berezin International Institute of Biological Systems, 43 Karl Marx str., Pesochnyi, Saint Petersburg, Russian Federation, 197758

For correspondence: Nikolai Vasil’evich Il’in, PhD, Professor, 70 Leningradskaya str., Pesochnyi, Saint Petersburg, Russian Federation, 197758; Tel.: +7(812)596-90-35; e-mail: ilyin_prof@mail.ru.

For citation: Vinogradova YuN, Ivanova EI, Chumachenko AI, et al. Conventional and Conformal Radiotherapy with and without Beam Intensity Modulation in Patients with Stage II Hodgkin’s Lymphoma with Supradiaphragmal Lesions. Clinical oncohematology. 2018;11(1):70-7.

DOI: 10.21320/2500-2139-2018-11-1-70-77

ABSTRACT

Aim. To increase the efficacy of chemo-radiotherapy in patients with stage II Hodgkin’s lymphoma (HL) with supradiaphragmal lesions by different fractionation (conventional fractionation [CF] and multi-fractionation [MF]) and various radiation volume (mantle radiotherapy, involved field radiotherapy [IFRT] or involved site radiotherapy [ISRT]).

Materials & Methods. The clinical trial included 317 patients with stage II classical HL with supradiaphragmal lesions who have received chemo-radiotherapy in AM Granov Russian Scientific Centre of Radiology and Surgery Technologies from 1986 to 2015 (n = 301) and in SM Berezin International Institute of Biological Systems from 2014 to 2016 (n = 16). The mean age was 30.9 years (range 18–65); the study group included 107 men and 210 women. The diagnosis in all the cases was confirmed by immunomorphologic analysis. The treatment program included 2 to 6 cycles of ABVD regimen followed by CF (n = 153) or MF (n = 148) radiation therapy. The patients received mantle radiotherapy or IFRT with the cumulative dose of 30 to 40 Gy (2D planning, 237 patients) or ISRT with the cumulative dose of 30 to 40 Gy (3D planning, n = 80, CF only). The MF-regimen was administered only with 2D planning, mantle radiotherapy and IFRT. The CF-regimen was administered with 2D-planning (n = 89) with the same volume of radiation and 3D planning using conformal RT (3D-CRT) as ISRT with the cumulative dose of 30 to 36 Gy (n = 80). From the total of 80 patients 16 patients were treated with beam intensity modulation (IMRT) and 64 patients were treated without IMRT.

Results. The treatment response (both complete and partial remission) was reported in 235 (99.2 %) of 237 patients of 2D planning group. In 2 cases (0.8 %) a progression of disease was diagnosed. Out of 235 patients with remission 222 (94.5 %) had a complete remission and 13 (5.5 %) had a partial remission. Within the group treated with the conventional RT 19 (8.1 %) patients had recurrent disease. Overall 5- and 10-year survival (OS) was equal and accounted for 98.0 ± 1.4 %, the disease-free survival (DFS) was also equal between groups and accounted for 85.9 ± 1.3 %. The rate of 5- and 10-year OS in patients who received CF was 97.8 ± 1.7 %; the DFS rate for the same period was 85.0 ± 1.5 % with standard fractionation and 86.2 ± 1.6 % with MF (p > 0.1). The total number of local radiation reactions and the number of radiation pulmonitis were significantly smaller with the exposure twice daily compared to CF at 2D planning and mantle irradiation. Decreasing the radiation volume from the mantle type to IFRT was shown to reduce the incidence of pulmonitis. The incidence of esophagitis remained the same with different fractionation and the irradiation volumes specified above. The results of the analysis proved the total absence of radiation pericarditis with both types of conformal RT with or without IMRT. No pulmonitis cases were observed with IMRT; the use of 3D-CRT and 2D-RT significantly increased the incidence of pulmonitis. The incidence of esophagitis within the CRT-group (n = 80) was 2 times lower compared to the conventional RT (22.5 % and 43.9 %; p < 0.01).

Conclusion. The innovative technologies of radiation therapy allowed to reduce the incidence of early local radiation reactions. These technologies will be the basis for preventing severe late radiation complications that reduce the life expectancy and quality of life of patients with HL.

Keywords: Hodgkin’s lymphoma, radiotherapy, fractionation, 2D and 3D planning.

Received: September 16, 2017

Accepted: December 5, 2017

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Radiotherapy in combined treatment of patients with diffuse large B-cell lymphoma

CLINICAL PRESENTATION, DIAGNOSIS, AND MANAGEMENT OF LYMPHOID MALIGNANCIES , , ,

Yu.N. Vinogradova, N.V. Ilin, D.V. Larionov, M.M. Khodzhibekova, N.A. Kostenikov, and L.I. Korytova

Russian Research Centre for Radiology and Surgical Technologies, RF Ministry of Health, Saint Petersburg, Russian Federation

ABSTRACT

The study included 86 primary patients (age: 18–83) with diffuse large B-cell lymphoma, I to IV stages, who received (R)-CHOP regimen and radiotherapy at the CRIRR (at present RRCRST) over the period 2000–2012. The follow-up period median was 42 months (5–120 months). Positron emission tomography (PET) with 18F-FDG was performed in 45 patients at the various follow-up time-points. In all patients, the changes of hematologic indices were observed using baseline, pre-, and postradiation measurements. After combined treatment completed, remission was achieved in 80 out of 86 (93.0 %) patients, including complete or uncertain complete remission and partial remission in 86.0 % and 7.0 %, respectively. During the initial therapy, disease progression occurred in 6 (7.0 %) patients. After the chemotherapy stage, complete remission was noted in 56 (65.1 %) patients only. Additional radiotherapy promoted the increase in the rate of complete and uncertain complete response by 21.9 %. Disseminated disease relapses developed in 2 out of 80 (2.5 %) patients. The complete response rate in the patients who received radiotherapy using the various fractionation regimens was similar. 5-year overall, relapse-free, and progression–free survival were 89.7 ± 3.9 %, 96.6 ± 2.4 %, and 85.4 ± 4.8 %, respectively. In 20.6 % of the patients examined after chemotherapy, PET gave positive results, while after the radiotherapy stage, all the patients examined at this time-point were PET-negative. Radiotherapy was accompanied by mainly I–II grade hematologic toxicity, and in 16–58 % of patients, no interruption of treatment were required. Neutropenia and thrombocytopenia occurred more frequently at the twice-a-day irradiation.

Keywords: diffuse large B-cell lymphoma, radiotherapy, positron emission tomography, hematologic toxicity.

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Past and present of radiotherapy in management of malignancies

REVIEWS , , ,

O.P. Trofimova, S.I. Tkachev, and T.V. Yuryeva

N.N. Blokhin Russian Cancer Research Center, RAMS, Moscow, Russian Federation

ABSTRACT

The article describes the stages of emergence and development of radiotherapy in management of malignancies of various locations, covering the period from the discovery of X-rays to the use of 60Co artificial isotope and development of the linear electron accelerator. Currently, radiotherapy is required for 70 % of cancer patients at some stage of tumor treatment. Improvements in radiotherapy technologies and development of new irradiation techniques made possible to solve the main task of radiotherapy, i.e. tumor destruction with minimal radiation exposure to surrounding healthy tissues, at the time being. This paper describes the radiotherapy techniques and explains in detail the differences between conventional and conformal radiotherapy. Also, preparation of patients for radiotherapy and the features of various conformal radiotherapy technologies are included.

Keywords: irradiation, radiotherapy, preparation for radiotherapy, linear electron accelerator.

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