title: Can treatment of pediatric Hodgkin's lymphoma be improved by PET imaging and proton therapy?
abstract: OBJECTIVE
  To explore a new positron emission tomography (PET)-based target concept for pediatric Hodgkin's lymphoma (PHL).
  
  
  METHODS
  For 10 patients, the planning target volume PTV1 was based on initial CT tumor extension and PTV2 on anatomy-related PET-positive lymph node levels after chemotherapy. The treatment techniques investigated (prescribed dose 19.8 Gy) comprised opposed-field (2F), intensity-modulated photon (IMXT), and single-field (PS) proton techniques. Treatment concepts were compared concerning dose-volume histogram (DVH) parameters and organ-equivalent doses (OED).
  
  
  RESULTS
  The median PTV1 and PTV2 were 902 ± 555 cm(3) and 281 ± 228 cm(3). When using PTV2 instead of PTV1 for all techniques, the D(2%) of the heart was reduced from 14 to 9 Gy and the D(mean) of the thyroid from 16.6 to 2.7 Gy. Low- (20%), median- (50%), and high-dose volumes (80%) were reduced by 60% for the heart and bones using PTV2. PS reduced the high-dose volume of the lungs and the heart by up to 60%. IMXT increased the low-dose volumes and OED. PTV2 reduced OED by 54 ± 10% for all organs at risk.
  
  
  CONCLUSIONS
  PTV2 has a high impact on the treated volume and on sparing of organs at risk. The combination of an adaptive target volume definition with protons could contribute to future PHL treatment concepts.
authors.affiliation: Department of Radiooncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. barbara.knaeusl@meduniwien.ac.at
authors.forename: B
authors.initials: B
authors.lastname: Knäusl
authors.forename: C
authors.initials: C
authors.lastname: Lütgendorf-Caucig
authors.forename: J
authors.initials: J
authors.lastname: Hopfgartner
authors.forename: K
authors.initials: K
authors.lastname: Dieckmann
authors.forename: L
authors.initials: L
authors.lastname: Kurch
authors.forename: T
authors.initials: T
authors.lastname: Pelz
authors.forename: R
authors.initials: R
authors.lastname: Pötter
authors.forename: D
authors.initials: D
authors.lastname: Georg
mesh_terms: D001842:Bone and Bones / Q000528:radiation effects; D001940:Breast / Q000528:radiation effects; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D006321:Heart / Q000528:radiation effects; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D061766:Proton Therapy / Q000379:methods*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated; D012307:Risk Factors; D013961:Thyroid Gland / Q000528:radiation effects; D014057:Tomography, X-Ray Computed