Review - (2025) Volume 7, Issue 2
Radiotherapy for early-stage Hodgking's lymphoma (HL) has recently been subjected to a variety of planning techniques, with the use of intensity modulated radiotherapy (IMRT) associated with radiation volumes. Currently, IMRT can be planned and delivered by various techniques and this role is not completely clear. In this study, we aimed to evaluate different IMRT planning designs regarding plan quality and treatment delivery efficiency. Materials and Methods: A 17-year-old patient affected by early-stage mediastinal HL was planned. Three different treatment techniques were compared: 3D-CRT, B-VMAT ("butterfly", multiple arcs), B-IMRT ("butterfly", intensity modulated radiotherapy). The beam energy was 6 MV and all IMRT planning solutions were optimised by reverse planning with specific dose volume constraints on the OAR (lungs, thyroid gland, heart, oral cavity). Our plan was planned as 30Gy and 10 fractions. Dose-volume histograms (DVHs) and Conformity Index (CI) were calculated and then compared between the target and OAR by statistical analysis. Results: V95% ≥95% was achieved in all plans within the PTV; The highest mean CI was obtained with B-VMAT (1.50) and B-IMRT (1.80). For the lungs, B-VMAT (V_20=38.1% and mean=17.3%), B-IMRT (V_20=42.1% and mean=18.4%) and B-VMAT doses provided better protection in terms of volumes received. Thyroid glands were close to each other as B-VMAT (Mean=20.5%), B-VMAT (Mean=19.25%). Heart doses B-VMAT (Mean=24,7%), B-IMRT (Mean=17,9%) provided better protection in B-IMRT( Table 1.) The values were within the limits. Conclucions: B-VMAT techniques showed superior target coverage with lower doses to healthy tissues (lungs) as expected. The B-IMRT technique, as an alternative planning solution in terms of conformity index and evaluation of other OARs, has emerged as the planning solution that can provide the most balanced compromise between OAR volumes.
Abstract
Radiotherapy for early-stage Hodgking's lymphoma (HL) has recently been subjected to a variety of planning techniques, with the use of intensity modulated radiotherapy (IMRT) associated with radiation volumes. Currently, IMRT can be planned and delivered by various techniques and this role is not completely clear. In this study, we aimed to evaluate different IMRT planning designs regarding plan quality and treatment delivery efficiency. Materials and Methods: A 17- year-old patient affected by early-stage mediastinal HL was planned. Three different treatment techniques were compared: 3D-CRT, B-VMAT ("butterfly", multiple arcs), B-IMRT ("butterfly", intensity modulated radiotherapy). The beam energy was 6 MV and all IMRT planning solutions were optimised by reverse planning with specific dose volume constraints on the OAR (lungs, thyroid gland, heart, oral cavity). Our plan was planned as 30Gy and 10 fractions. Dose-volume histograms (DVHs) and Conformity Index (CI) were calculated and then compared between the target and OAR by statistical analysis. Results: V95% ≥95% was achieved in all plans within the PTV; The highest mean CI was obtained with B-VMAT (1.50) and B-IMRT (1.80). For the lungs, B-VMAT (V_20=38.1% and mean=17.3%), B-IMRT (V_20=42.1% and mean=18.4%) and B-VMAT doses provided better protection in terms of volumes received. Thyroid glands were close to each other as B-VMAT (Mean=20.5%), B-VMAT (Mean=19.25%). Heart doses B-VMAT (Mean=24,7%), B-IMRT (Mean=17,9%) provided better protection in B-IMRT( Table 1.) The values were within the limits. Conclucions: B-VMAT techniques showed superior target coverage with lower doses to healthy tissues (lungs) as expected. The B-IMRT technique, as an alternative planning solution in terms of conformity index and evaluation of other OARs, has emerged as the planning solution that can provide the most balanced compromise between OAR volumes.
Published: 30-Sep-2025, DOI: 10.35248/clinical-oncology.25.7(2)001-003
Copyright:This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
