title: Prospective phase II trial of image-guided radiotherapy in Hodgkin lymphoma: benefit of deep inspiration breath-hold.
abstract: BACKGROUND
  Long-term Hodgkin lymphoma (HL) survivors have an increased risk of late cardiac morbidity and secondary lung cancer after chemotherapy and mediastinal radiotherapy. In this prospective study we investigate whether radiotherapy with deep inspiration breath-hold (DIBH) can reduce radiation doses to the lungs, heart, and cardiac structures without compromising the target dose.
  
  
  METHODS
  Twenty-two patients (14 female, 8 male), median age 30 years (18-65 years), with supra-diaphragmatic HL were enrolled and had a thoracic PET/CT with DIBH in addition to staging FDG-PET/CT in free breathing (FB) and a planning CT in both FB and DIBH. For each patient an involved-node radiotherapy plan was done for both DIBH and FB, and the doses to the lungs, heart, and female breasts were recorded prospectively. Mean doses to the heart valves and coronary arteries were recorded retrospectively. Patients were treated with the technique yielding the lowest doses to normal structures.
  
  
  RESULTS
  Nineteen patients were treated with DIBH and three with FB. DIBH reduced the mean estimated lung dose by 2.0 Gy (median: 8.5 Gy vs. 7.2 Gy) (p < 0.01) and the mean heart dose by 1.4 Gy (6.0 Gy vs. 3.9 Gy) (p < 0.01) compared to FB. The lung and heart V20Gy were reduced with a median of 5.3% and 6.3%. Mean doses to the female breasts were equal with FB and DIBH.
  
  
  CONCLUSIONS
  DIBH can significantly decrease the estimated mean doses to the heart and lungs without lowering the dose to the target in radiotherapy for patients with mediastinal HL.
authors.affiliation: Department of Oncology, Section for Radiotherapy, Rigshospitalet, University of Copenhagen , Denmark.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Petersen
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Aznar
authors.forename: Anne K
authors.initials: AK
authors.lastname: Berthelsen
authors.forename: Annika
authors.initials: A
authors.lastname: Loft
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Schut
authors.forename: Maja
authors.initials: M
authors.lastname: Maraldo
authors.forename: Mirjana
authors.initials: M
authors.lastname: Josipovic
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Klausen
authors.forename: Flemming L
authors.initials: FL
authors.lastname: Andersen
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001940:Breast / Q000528:radiation effects; D062485:Breath Holding; D005260:Female; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000528:radiation effects*; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D001239:Inhalation; D008168:Lung / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D058958:Organs at Risk / Q000528:radiation effects*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D019275:Radiopharmaceuticals; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18