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New Treatment Guideline for Pediatric Hodgkin Lymphoma

Recommendations minimize radiation dose

The International Lymphoma Radiation Oncology Group (ILROG) has issued a guideline that outlines the use of 3D computed tomography (CT)-based radiation therapy planning and volumetric image guidance to treat more effectively pediatric Hodgkin lymphoma and to reduce the radiation dose to normal tissue, thereby decreasing the risk of late adverse effects.

The guideline will be published in the March–April issue of Practical Radiation Oncology, the clinical practice journal of the American Society for Radiation Oncology.

Historically, pediatric patients with Hodgkin lymphoma are treated with the same chemotherapy and radiation regimens as adults with the disease, which potentially exposes their young, still-growing bodies to more treatment than necessary. Previous radiation therapy guidelines for pediatric Hodgkin lymphoma focused on two-dimensional imaging and bony landmarks to define dose volumes for radiation therapy, and treated large volumes of normal tissue partly because of uncertainty about which lymph-node areas were involved.

The new guideline describes how to effectively use modern imaging as well as innovations and advances in radiation therapy planning technology to treat patients with pediatric Hodgkin lymphoma while decreasing the risk of late adverse effects, including second cancers and heart disease.

The authors describe methods for identifying target volumes for radiation therapy and how to implement the concept of “involved-site radiation therapy” to define radiation target volumes and to limit the dose to normal organs at risk. According to the guideline, accurate assessment of the extent and location of the disease requires both contrast-enhanced CT as well as fluorodeoxyglucose positron emission tomography (FDG-PET).

The document describes the use of the recently developed capacity to fuse CT and FDG-PET images taken before and after chemotherapy to CT images taken for radiation therapy planning.

“The emergence of new imaging technologies, more accurate ways of delivering radiation therapy, and more detailed patient-selection criteria have made a significant change in our ability to customize treatment for many cancer patients,” said lead author David C. Hodgson, MD. “This guideline has the potential to reduce the radiation-therapy breast dose by about 80 percent and the heart dose by about 65 percent for an adolescent girl with Hodgkin lymphoma.”

Source: ASTRO; March 4, 2015.


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