title: Dosimetric benefits of intensity-modulated radiotherapy combined with the deep-inspiration breath-hold technique in patients with mediastinal Hodgkin's lymphoma.
abstract: OBJECTIVE
  To assess the additional benefits of using the deep-inspiration breath-hold (DIBH) technique with intensity-modulated radiotherapy (IMRT) in terms of the protection of organs at risk for patients with mediastinal Hodgkin's disease.
  
  
  METHODS
  Patients with early-stage Hodgkin's lymphoma with mediastinal involvement were entered into the study. Two simulation computed tomography scans were performed for each patient: one using the free-breathing (FB) technique and the other using the DIBH technique with a dedicated spirometer. The clinical target volume, planning target volume (PTV), and organs at risk were determined on both computed tomography scans according to the guidelines of the European Organization for Research and Treatment of Cancer. In both cases, 30 Gy in 15 fractions was prescribed. The dosimetric parameters retrieved for the statistical analysis were PTV coverage, mean heart dose, mean coronary artery dose, mean lung dose, and lung V20.
  
  
  RESULTS
  There were no significant differences in PTV coverage between the two techniques (FB vs. DIBH). The mean doses delivered to the coronary arteries, heart, and lungs were significantly reduced by 15% to 20% using DIBH compared with FB, and the lung V20 was reduced by almost one third. The dose reduction to organs at risk was greater for masses in the upper part of the mediastinum. IMRT with DIBH was partially implemented in 1 patient. This combination will be extended to other patients in the near future.
  
  
  CONCLUSIONS
  Radiation exposure of the coronary arteries, heart, and lungs in patients with mediastinal Hodgkin's lymphoma was greatly reduced using DIBH with IMRT. The greatest benefit was obtained for tumors in the upper part of the mediastinum. The possibility of a wider use in clinical practice is currently under investigation in our department.
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France. amaury.paumier@igr.fr
authors.forename: Amaury
authors.initials: A
authors.lastname: Paumier
authors.forename: Mithra
authors.initials: M
authors.lastname: Ghalibafian
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gilmore
authors.forename: Anne
authors.initials: A
authors.lastname: Beaudre
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanchard
authors.forename: Mohammed
authors.initials: M
authors.lastname: el Nemr
authors.forename: Farez
authors.initials: F
authors.lastname: Azoury
authors.forename: Hweej
authors.initials: H
authors.lastname: al Hamokles
authors.forename: Dimitri
authors.initials: D
authors.lastname: Lefkopoulos
authors.forename: Theodore
authors.initials: T
authors.lastname: Girinsky
mesh_terms: D003331:Coronary Vessels / Q000528:radiation effects; D019583:Dose Fractionation, Radiation; D006321:Heart / Q000528:radiation effects; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D058958:Organs at Risk / Q000528:radiation effects; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013147:Spirometry / Q000295:instrumentation; D047368:Tumor Burden