title: Active breathing control for Hodgkin's disease in childhood and adolescence: feasibility, advantages, and limits.
abstract: OBJECTIVE
  The challenge in early Hodgkin's disease (HD) in children is to maintain good survival rates while sparing organs at risk. This study assesses the feasibility of active breathing control (ABC) in children, and compares normal tissue irradiation with and without ABC.
  
  
  METHODS
  Between May 2003 and June 2004, seven children with HD with mediastinal involvement, median age 15, were treated by chemotherapy and involved-field radiation therapy. A free-breathing computed tomography simulation scan and one additional scan during deep inspiration using ABC were performed. A comparison between planning treatment with clinical target volume including supraclavicular regions, mediastinum, and hila was performed, both in free breathing and using ABC.
  
  
  RESULTS
  For a prescription of 36 Gy, pulmonary dose-volume histograms revealed a mean reduction in lung volume irradiated at more than 20 Gy (V20) and 30 Gy (V30) of 25% and 26%, respectively, using ABC (p = 0.016). The mean volume of heart irradiated at 30 Gy or more decreased from 15% to 12% (nonsignificant). The mean dose delivered to breasts in girls was small in both situations (less than 2 Gy) and stable with or without ABC. Considering axillary irradiation, the mean dose delivered to breasts remained low (<9 Gy), without significant difference using ABC or not. The mean radiation dose delivered to thyroid was stable using ABC or not.
  
  
  CONCLUSIONS
  Using ABC is feasible in childhood. The use of ABC decreases normal lung tissue irradiation. Concerning heart irradiation, a minimal gain is also shown. No significant change has been demonstrated concerning breast and thyroid irradiation.
authors.affiliation: Department of Radiotherapy, Centre Léon Bérard, Lyon, France. claude@lyon.fnclcc.fr
authors.forename: Line
authors.initials: L
authors.lastname: Claude
authors.forename: Claude
authors.initials: C
authors.lastname: Malet
authors.forename: Pascal
authors.initials: P
authors.lastname: Pommier
authors.forename: Philippe
authors.initials: P
authors.lastname: Thiesse
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chabaud
authors.forename: Christian
authors.initials: C
authors.lastname: Carrie
mesh_terms: D000293:Adolescent; D001940:Breast / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000528:radiation effects; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008297:Male; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D012119:Respiration; D013961:Thyroid Gland / Q000528:radiation effects; D014057:Tomography, X-Ray Computed