title: Comparison of passive-beam proton therapy, helical tomotherapy and 3D conformal radiation therapy in Hodgkin's lymphoma female patients receiving involved-field or involved site radiation therapy.
abstract: OBJECTIVE
  Second cancers and cardiovascular toxicities are long term radiation toxicity in locally advanced Hodgkin's lymphomas. In this study, we evaluate the potential reduction of dose to normal tissue with helical tomotherapy and proton therapy for Hodgkin's lymphoma involved-field or involved-site irradiation compared to standard 3D conformal radiation therapy.
  
  
  METHODS
  Fourteen female patients with supradiaphragmatic Hodgkin's lymphoma were treated at our institution with 3D conformal radiation therapy or helical tomotherapy to a dose of 30Gy in 15 fractions. A planning comparison was achieved including proton therapy with anterior/posterior passive scattered beams weighted 20Gy/10Gy.
  
  
  RESULTS
  Mean doses to breasts, lung tissue and heart with proton therapy were significantly lower compared to helical tomotherapy and to 3D conformal radiation therapy. Helical tomotherapy assured the best protection of lungs from doses above 15Gy with the V20Gy equal to 16.4%, compared to 19.7% for proton therapy (P=0.01) or 22.4% with 3D conformal radiation therapy (P<0.01). Volumes of lung receiving doses below 15Gy were significantly larger for helical tomotherapy than for proton therapy or 3D conformal radiation therapy, with respective lung doses V10Gy=37.2%, 24.6% and 27.4%. Also, in the domain of low doses, the volumes of breast that received more than 10Gy or more than 4Gy with helical tomotherapy were double the corresponding volumes for proton therapy, with V4Gy representing more than a third of one breast volume with helical tomotherapy.
  
  
  CONCLUSIONS
  Helical tomotherapy achieved a better protection to the lungs for doses above 15Gy than passive proton therapy or 3D conformal radiation therapy. However, dose distributions could generally be improved by using protons even with our current passive-beam technology, especially allowing less low dose spreading and better breast tissue sparing, which is an important factor to consider when treating Hodgkin's lymphomas in female patients. Prospective clinical study is needed to evaluate the tolerance and confirm these findings.
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Horn
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Fournier-Bidoz
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Pernin
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Peurien
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Vaillant
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Dendale
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
authors.affiliation: Department of Radiation Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France. Electronic address: youlia.kirova@curie.fr.
authors.forename: Y M
authors.initials: YM
authors.lastname: Kirova
mesh_terms: D000328:Adult; D001940:Breast / Q000528:radiation effects; D005260:Female; D006321:Heart / Q000528:radiation effects; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008168:Lung / Q000528:radiation effects; D008479:Mediastinal Neoplasms / Q000532:radiotherapy*; D059351:Organ Sparing Treatments; D058958:Organs at Risk; D061766:Proton Therapy; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D055815:Young Adult
keywords: Breast sparing; Helical tomotherapy; Lymphome médiastinal; Mediastinal lymphoma; Organes à risque; Organs at risk; Protection mammaire; Protons; Tomothérapie