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International Lymphoma Radiation Oncology Group Issues Treatment Guidelines for Pediatric Hodgkin Lymphoma

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Key Points

  • Historically, pediatric Hodgkin lymphoma patients were treated with the same chemotherapy and radiation regimens as adults with Hodgkin lymphoma.
  • The guideline focuses on the concept of “involved-site radiation therapy” to define radiation target volumes and limit dosage to normal organs at risk.
  • The guideline has the potential to reduce the radiation therapy breast dose by about 80% and the heart dose by about 65% for an adolescent girl with Hodgkin lymphoma.

The International Lymphoma Radiation Oncology Group (ILROG) has issued a guideline outlining the use of three-dimensional (3D) computed tomography (CT)–based radiation therapy planning and volumetric image guidance, specifically to more effectively treat pediatric Hodgkin lymphoma. The guideline aims to reduce the radiation dose to normal tissue through its recommendations, thus decreasing the risk of late side effects. The guideline is published in the March/April issue of Practical Radiation Oncology (PRO).

The guideline, “Implementation of Contemporary Radiation Therapy Planning Concepts for Pediatric Hodgkin Lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group,” describes how to effectively use modern imaging innovations and advances in radiation therapy planning technology to treat patients while decreasing the risk of late side effects, including secondary cancers and heart disease.

Focus of the Guideline

Historically, pediatric Hodgkin lymphoma patients were treated with the same chemotherapy and radiation regimens as adults with Hodgkin lymphoma, which potentially exposed their young, still-growing bodies to excessive treatment risks. Previous radiation therapy guidelines for pediatric Hodgkin lymphoma have focused on two-dimensional imaging and bony landmarks to define dose volumes for radiation therapy treatment. Large volumes of normal tissue were exposed to treatment in these processes, in part because of uncertainty about which lymph node areas were involved.  

The authors describe methods for identifying target volumes for radiation therapy and how to implement the concept of “involved-site radiation therapy” to define radiation target volumes and limit dosage to normal organs at risk. According to the guideline, accurate assessment of the extent and location of disease requires both contrast-enhanced CT as well as 18F–fluorodeoxyglucose (FDG)–positron-emission tomography (PET). It goes on to describe how the evaluation of response to chemotherapy influences the targeting of the lymphoma and the volume of normal tissue treated. This is achieved by using recently developed capacity to fuse CT and FDG-PET images, taken before and after chemotherapy, to CT imaging taken for radiation therapy planning.

Potential Effects

“The emergence of new imaging technologies, more accurate ways of delivering radiation therapy, and more detailed patient selection criteria have made a significant change in our ability to customize treatment for many cancer patients,” said David C. Hodgson, MD, Associate Professor in the Department of Radiation Oncology at the University of Toronto, radiation oncologist at Princess Margaret Hospital/University Health Network in Toronto, and lead author of the guideline. “This guideline has the potential to reduce the radiation therapy breast dose by about 80%, and the heart dose by about 65%, for an adolescent girl with Hodgkin lymphoma. This shift in more personalized treatment planning tailored to the individual patient’s disease will optimize risk-benefit considerations for our patients and reduce the likelihood that they will suffer late effects from radiation therapy.”

Dr. Hodgson is the corresponding author for the Practical Radiation Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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