title: Dosimetric evaluation and treatment outcome of intensity modulated radiation therapy after doxorubicin-based chemotherapy for primary mediastinal large B-cell lymphoma.
abstract: OBJECTIVE
  The value of intensity-modulated radiation therapy (IMRT) after doxorubicin-based chemotherapy in primary mediastinal large B-cell lymphoma (PMBCL) is unknown. We assessed the dosimetric parameters, treatment outcomes, and toxicity of IMRT in PMBCL.
  
  
  METHODS
  Forty-one PMBCL patients underwent mediastinal IMRT after doxorubicin-based chemotherapy. Thirty-eight patients had stage I-II disease, and 3 patients had stage III-IV disease. Most patients presented with bulky mediastinal disease (65.9%) and local invasion (82.9%). The dose-volume histograms of the target volume and critical normal structures were evaluated.
  
  
  RESULTS
  The average planning target volume (PTV) mean dose was 39 Gy. Only 0.5% and 1.4% of the PTV received <90% and <95% of the prescribed dose, respectively, indicating excellent target coverage. The median mean lung dose and percentage lung volume receiving 20 Gy (V20) were 16.3 Gy and 30.6%. The 5-year overall survival (OS) and local control (LC) were 95.1% and 89.8%. After chemotherapy, consolidation radiation therapy in patients with complete/partial response resulted in significantly better survival than salvage radiation therapy in patients with stable/progressive disease (3-year OS 100% vs 75%; 3-year LC 96.6% vs 62.5%). No grade 4 or 5 acute or late toxicities occurred.
  
  
  CONCLUSIONS
  Mediastinal IMRT after doxorubicin-based chemotherapy can be safely and efficiently delivered, and it provides favorable outcomes in PMBCL patients with a large target volume and high-risk features.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, P R China.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Xu
authors.forename: Ye-Xiong
authors.initials: YX
authors.lastname: Li
authors.forename: Hui
authors.initials: H
authors.lastname: Fang
authors.forename: Jing
authors.initials: J
authors.lastname: Jin
authors.forename: Wei-Hu
authors.initials: WH
authors.lastname: Wang
authors.forename: Shu-Lian
authors.initials: SL
authors.lastname: Wang
authors.forename: Yue-Ping
authors.initials: YP
authors.lastname: Liu
authors.forename: Yong-Wen
authors.initials: YW
authors.lastname: Song
authors.forename: Qing-Feng
authors.initials: QF
authors.lastname: Liu
authors.forename: Bo
authors.initials: B
authors.lastname: Chen
authors.forename: Shu-Nan
authors.initials: SN
authors.lastname: Qi
authors.forename: Hua
authors.initials: H
authors.lastname: Ren
authors.forename: Jian-Rong
authors.initials: JR
authors.lastname: Dai
mesh_terms: D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006321:Heart / Q000528:radiation effects; D006801:Humans; D008168:Lung / Q000528:radiation effects; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D058958:Organs at Risk / Q000528:radiation effects; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012008:Recurrence; D012074:Remission Induction; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin