title: Estimated risk of cardiovascular disease and secondary cancers with modern highly conformal radiotherapy for early-stage mediastinal Hodgkin lymphoma.
abstract: BACKGROUND
  Hodgkin lymphoma (HL) survivors have an increased morbidity and mortality from secondary cancers and cardiovascular disease (CD). We evaluate doses with involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3D CRT), volumetric modulated arc therapy (VMAT), or proton therapy (PT), compared with the extensive Mantle Field (MF).
  
  
  METHODS
  For 27 patients with early-stage, mediastinal HL, treated with chemotherapy and INRT delivered as 3D CRT (30 Gy), we simulated an MF (36 Gy), INRT-VMAT and INRT-PT (30 Gy). Dose to the heart, lungs, and breasts, estimated risks of CD, lung (LC) and breast cancer (BC), and corresponding life years lost (LYL) were compared.
  
  
  RESULTS
  3D CRT, VMAT or PT significantly lower the dose to the heart, lungs and breasts and provide lower risk estimates compared with MF, but with substantial patient variability. The risk of CD is not significantly different for 3D CRT versus VMAT. The risk of LC and BC is highest with VMAT. For LYL, PT is the superior modern technique.
  
  
  CONCLUSIONS
  In early-stage, mediastinal HL modern radiotherapy provides superior results compared with MF. However, there is no single best radiotherapy technique for HL-the decision should be made at the individual patient level.
authors.affiliation: Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. dra.maraldo@gmail.com
authors.forename: M V
authors.initials: MV
authors.lastname: Maraldo
authors.forename: N P
authors.initials: NP
authors.lastname: Brodin
authors.forename: M C
authors.initials: MC
authors.lastname: Aznar
authors.forename: I R
authors.initials: IR
authors.lastname: Vogelius
authors.forename: P
authors.initials: P
authors.lastname: Munck af Rosenschöld
authors.forename: P M
authors.initials: PM
authors.lastname: Petersen
authors.forename: L
authors.initials: L
authors.lastname: Specht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001940:Breast / Q000528:radiation effects; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006321:Heart / Q000528:radiation effects; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000528:radiation effects; D015182:Lymphatic Irradiation; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D058958:Organs at Risk / Q000528:radiation effects*; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated; D012306:Risk; D055815:Young Adult
keywords: Hodgkin lymphoma; cardiovascular disease; highly conformal radiotherapy; involved node radiotherapy; secondary cancers