Contribution of three-dimensional conformal intensity-modulated radiation therapy for women affected by bulky stage II supradiaphragmatic Hodgkin disease

PURPOSE To analyze the outcome and dose distribution of intensity-modulated radiation therapy (IMRT) by helical tomotherapy in women treated for large supradiaphragmatic Hodgkin's disease. MATERIAL AND METHODS A total of 13 patients received adjuvant radiation at a dose of 30 Gy to the initially involved sites with a boost of 6 Gy to those areas suspected of harboring residual disease on the simulation CT scan. RESULTS With a median follow-up of 23 months, the two-year progression-free survival was 91.6%, and the 2- and 3-year overall survivals were 100%. We did not report any heart or lung acute side effects. The conformity index of PTV (Planning Target Volume) was better for IMRT than for 3D-CRT (p=0.001). For the breasts, lungs, heart, thyroid and esophagus, the volume distributions favored the IMRT plans. For the breasts, the V(20Gy), V(25Gy) and V(30Gy) were 1.5, 2.5 and 3.5 times lower, respectively, for IMRT than for 3D-CRT. For the lung tissues, the V(20Gy) and V(30Gy) were 2 times and 4.5 times lower, respectively, for IMRT than for 3D-CRT. For the heart, the V(20Gy) and V(30Gy) were 1.4 and 2 times lower, respectively, for IMRT than for 3D-CRT. For the esophagus, the V(35Gy) was 1.7 lower for IMRT than for 3D-CRT, and for the thyroid, the V(30Gy) was 1.2 times lower for IMRT. CONCLUSION IMRT by helical tomotherapy improved the PTV coverage and dramatically decreased the dose in organs at risk. The treatment was well tolerated, but a longer follow-up is necessary to prove a translation of these dosimetric improvements in the outcome of the patients.