Everett AS, Hoppe BS, Louis D, McDonald AM, Morris CM, Mendenhall NP, Li Z, Flampouri S,
Comparison of Techniques for Involved-Site Radiation Therapy in Patients with Lower Mediastinal Lymphoma, Practical Radiation Oncology (2019), doi: https://doi.org/10.1016/ j.prro.2019.05.009.
In this study, various radiation techniques and doses to Organs At Risk (OARs) are compared to determine the optimal treatment technique in patients with lower mediastinal lymphoma involvement.
In patients with lower mediastinal lymphoma, radiation delivery is particularly challenging because of the proximity of the target to critical structures, such as the heart and its substructures, lungs, breast, and esophagus. Therefore, PT has been increasingly used in patients with mediastinal lymphoma given its ability to improve dose conformity and decrease radiation to normal tissues while providing equivalent target coverage
Patients with lower mediastinal lymphoma (LML) benefit dosimetrically from proton therapy (PT) compared with intensity-modulated radiotherapy (IMRT). The added dosimetric benefit of deep-inspiration breath-hold (DIBH) is unknown; therefore, we evaluated IMRT versus PT and free-breathing (FB) versus DIBH among patients with LML.
Proton therapy significantly decreased the dose to critical structures (heart, lungs, esophagus, thyroid, and non-target body), specifically in patients with mediastinal lymphomas. Therefore, when PT is available and the patient has lower mediastinal involvement, PT should be considered to maximally reduce the dose to nearby normal structures and decrease the risk of late toxicity associated with LM lymphoma radiation treatment.
Among patients with lower mediastinal lymphoma involvement, PT significantly reduces radiation to the lung, heart, esophagus, thyroid, and non-target body compared with IMRT.
PT can provide a significant benefit over IMRT techniques and should be considered in patients with lower mediastinal lymphoma involvement.