title: Radiation-induced second malignancies after involved-node radiotherapy with deep-inspiration breath-hold technique for early stage Hodgkin Lymphoma: a dosimetric study.
abstract: BACKGROUND
  To estimate the risk of radiation induced second cancers after radiotherapy using deep-inspiration breath-hold (DI) technique with three-dimensional conformal (3DCRT) and volumetric arc therapy (VMAT) for patients with Hodgkin's lymphoma (HL).
  
  
  METHODS
  Early-stage HL with mediastinal and supraclavicular involvement was studied using an Alderson phantom. A whole body CT was performed and all tissues were delineated. The clinical target volumes and planning target volumes (PTV) were determined according to the German Hodgkin study group guidelines. Free-breathing (FB) technique and DI technique were simulated by different safety margins for the PTV definition. In both cases, 30 Gy in 15 fractions was prescribed. Second cancer risk was estimated for various tissues with a second cancer model including fractionation.
  
  
  RESULTS
  When compared with FB-3DCRT, estimated relative life time attributable risk (LAR) of cancer induction after DI-3DCRT was 0.86, 0.76, 0.94 and 0.92 for breast, lung, esophagus and stomach, respectively. With DI-VMAT, the corresponding values were 2.05, 1.29, 1.01, 0.93, respectively. For breast cancer, the LAR observed with DI-VMAT was not substantially distinguishable from the LAR computed for mantle RT with an administered dose of 40 Gy.
  
  
  CONCLUSIONS
  This study suggests that DI may reduce the LAR of secondary cancers of all OARs and may be a valuable technique when using 3DCRT. Conversely, VMAT may increase substantially the LAR and should be cautiously implemented in clinical practice.
authors.affiliation: Faculty of Science, Universtiy of Zürich, Zürich, Switzerland. uwe.schneider@uzh.ch.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schneider
authors.forename: Marcin
authors.initials: M
authors.lastname: Sumila
authors.forename: Judith
authors.initials: J
authors.lastname: Robotka
authors.forename: Damien
authors.initials: D
authors.lastname: Weber
authors.forename: Günther
authors.initials: G
authors.lastname: Gruber
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology; D062485:Breath Holding; D005260:Female; D006689:Hodgkin Disease / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D001239:Inhalation; D015182:Lymphatic Irradiation / Q000009:adverse effects* / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D055815:Young Adult