title: Doses to head and neck normal tissues for early stage Hodgkin lymphoma after involved node radiotherapy.
abstract: OBJECTIVE
  To evaluate dose plans for head and neck organs at risk (OARs) for classical Hodgkin lymphoma (HL) patients using involved node radiotherapy (INRT) delivered as 3D conformal radiotherapy (3DCRT), volumetric modulated arc therapy (VMAT), and intensity modulated proton therapy (PT), in comparison to the past mantle field (MF).
  
  
  METHODS
  Data from 37 patients with cervical lymph node involvement were used. All patients originally received chemotherapy followed by 3DCRT-INRT (30.6 Gy). A VMAT-INRT, PT-INRT (both 30.6 Gy), and a MF plan (36 Gy) were simulated. Doses to head and neck OARs were compared with cumulative DVHs and repeated measures ANOVA.
  
  
  RESULTS
  The estimated median mean doses were 15.3, 19.3, 15.4, and 37.3 Gy (thyroid), 10.9, 12.0, 7.9, and 34.5 Gy (neck muscles), 2.3, 11.1, 1.8, and 37.1 Gy (larynx), 1.7, 5.1, 1.3, and 23.8 Gy (pharynx), 0.5, 0.8, 0.01, and 32.3 Gy (ipsilateral parotid), and 2.4, 3.8, 0.7, and 34.7 Gy (ipsilateral submandibular) with 3DCRT, VMAT, PT, and MF (all p<0.0001), respectively.
  
  
  CONCLUSIONS
  The use of INRT significantly lowered the estimated radiation dose to the head and neck OARs. VMAT appeared suboptimal compared to 3DCRT and PT, and for some patients, PT offered an additional gain.
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA. Electronic address: dra.maraldo@gmail.com.
authors.forename: M V
authors.initials: MV
authors.lastname: Maraldo
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA.
authors.forename: N P
authors.initials: NP
authors.lastname: Brodin
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA; Niels Bohr Institute, Faculty of Sciences, University of Copenhagen, Denmark.
authors.forename: M C
authors.initials: MC
authors.lastname: Aznar
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA.
authors.forename: I R
authors.initials: IR
authors.lastname: Vogelius
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA; Niels Bohr Institute, Faculty of Sciences, University of Copenhagen, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Munck Af Rosenschöld
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA; Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark; Department of Hematology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: P M
authors.initials: PM
authors.lastname: Petersen
authors.affiliation: Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, NY, USA; Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark; Department of Hematology, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Specht
mesh_terms: D000328:Adult; D005260:Female; D006257:Head / Q000528:radiation effects*; D006689:Hodgkin Disease / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000528:radiation effects*; D009367:Neoplasm Staging; D058958:Organs at Risk; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects
keywords: 3DCRT; Hodgkin lymphoma; Normal tissues; Proton therapy; Radiotherapy; VMAT