Reviewing of radical radiotherapy to the mediastinum in patients with lymphoma
Main Article Content
Keywords
lymphoma, diffuse large B-cell lymphoma, median survival, non-Hodgkin lymphoma
Abstract
Background: Historically and clinically, lymphomas are categorized into two major groups: Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Over the years, radiotherapy techniques have advanced from extended-field to involved-field and more recently to involved-site/involved node radiation therapy (RT) (ISRT/INRT). Aim: This study aimed to evaluate the efficacy of mediastinal radiotherapy in lymphoma patients in Iraq. Methods: A prospective study was conducted to assess clinical and dosimetric changes in various radiotherapy planes and dosimetry between January 2023 and December 2023. The data collected included The data collected included patient demographics, medical history, treatment details, lymphoma characteristics, staging, radiotherapy plans, dose/fraction, and organ doses. Results: The study included 30 lymphoma patients (19 HL and 11 NHL cases) with a mean age of 31.3 ± 9.11 years. The non-coplanar group demonstrated superior mean PTV coverage compared to the coplanar volumetric modulated arc therapy (VMAT) group (P = 0.005). Additionally, the mean heart dose in the coplanar plans was greater than that in the non-coplanar arm (p < 0.0001). The coplanar plans also showed higher mean doses to the left lung at V20 in comparison to the non-coplanar plans (p = 0.007). Furthermore, the mean dose to the spinal cord in the coplanar VMAT group was greater than that in the non-coplanar group (p = 0.003). The median survival times were 11 months for HL and 12 months for NHL. Patients treated with coplanar plans had a median survival of 10.36 months, while those treated with non-coplanar plans had a median survival of 8.13 months. The recurrence rate was 23.3%, with a 3.3% risk of cardiac toxicity. Conclusions: The mean PTV coverage in the non-coplanar group surpassed that of the coplanar VMAT group. The median survival for HL patients was less than that for NHL patients within the same follow-up period. The survival rate of patients under coplanar plans exceeded that of patients under non-coplanar plans.
References
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2. Le Guyader-Peyrou S, Belot A, Maynadié M, Binder-Foucard F, Remontet L, Troussard X, et al. Cancer incidence in France over the 1980–2012 period: hematological malignancies. Rev Epidemiol Sante Publique. 2016 Apr;64(2):103–12.
3. Sant M, Minicozzi P, Mounier M, Anderson LA, Brenner H, Holleczek B, et al. Survival for haematological malignancies in Europe between 1997 and 2008 by region and age: results of EUROCARE-5, a population-based study. Lancet Oncol. 2014; 15(9): 931–42.
4. McCarten KM, Nadel HR, Shulkin BL, Cho SY. Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma. Pediatr Radiol. 2019 Oct;49(11):1545–64
5. Voorhees TJ, Beaven AW. Therapeutic Updates for Relapsed and Refractory Classical Hodgkin Lymphoma. Cancers (Basel). 2020 Oct 8;12(10):2887.
6. Juul SJ, Rossetti S, Kicinski M, van der Kaaij MAE, Giusti F, Meijnders P, et al. Employment situation among long-term Hodgkin lymphoma survivors in Europe: an analysis of patients from nine consecutive EORTC-LYSA trials. J Cancer Surviv. 2024;18(3):727–38.
7. Kanagalingam T, Velker V, Pejhan S, Zhang Q, Mangel J, Young S. Isolated Hodgkin lymphoma of the intracranial dura: a case report and review of the literature. Clin Case Rep. 2023 Jun 22;11(6):e7562
8. Andrea KN, Lawrence MW, Ann SL. Hodgkin’s lymphoma. In: Gunderson LL, Tepper JE, editors. Clinical radiation oncology. 4th ed. Netherlands: Elsevier, Inc.; 2016. p. 1506–21.
9. Prosnitz LR, Palta M, Kelsey CR. Non-Hodgkin lymphomas. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez & Brady’s principles and practice of radiation oncology. 6th ed. USA: Lippincott Williams & Wilkins; 2013. p. 1547–73.
10. Iraqi Cancer Registry. Reports of Republic of Iraq Ministry of Health and Environment. Iraqi Cancer Board; 2021. p. 30–6.
11. International Agency for Research on Cancer. Data visualization tools for exploring the global cancer burden in 2022 [Internet]. 2022. [cited 2023 April 22]. Available from: https://gco.iarc.fr/today/fact-sheets-cancers. 2022.
12. Bray F, Parkin DM; African Cancer Registry Network. Cancer in sub-Saharan Africa in 2020: a review of current estimates of the national burden, data gaps, and future needs. Lancet Oncol. 2022 Jun;23(6):719-728.
13. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.
14. Eich HD, Kriz J, Sasse S, Gorgen H, Borchmann P, Mueller R, et al. Involved-field (IF) versus extended-field (EF) radiation therapy (RT) for patients in early unfavorable stages of Hodgkin lymphoma: 10-year update of the HD8 trial of the German Hodgkin Study Group (GHSG). Int J Radiat Oncol Biol Phys. 2012;84(3):S70. Available from: http://dx.doi.org/10.1016/j.ijrobp.2012.07.288
15. Specht L, Yahalom J, Illidge T, Berthelsen AK, Constine LS, Eich HT, et al. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys. 2014; 89(4):854–62.
16. Alhilfi HSQ, Kassid OM, Jihad HJI, Alshewered ASH. Patterns of lymphoma in Misan city, Iraq: a retrospective observational study. F1000 Res. 2019;8:1733.
17. Sollini M, Kirienko M, Cavinato L, Ricci F, Biroli M, Ieva F, et al. Methodological framework for radiomics applications in Hodgkin's lymphoma. Eur J Hybrid Imaging. 2020 Jun 1;4(1):9.
18. Banerjee D. Recent advances in the pathobiology of Hodgkin's lymphoma: potential impact on diagnostic, predictive, and therapeutic strategies. Adv Hematol. 2011;2011:439456.
19. Sylvia MT, Dey B, Basu D, Jacob SE, Kar R, Dubashi B. Follicular lymphoma: a clinicopathological analysis from a tertiary care institute in southern India. Mediterr J Hematol Infect Dis. 2016 Nov 1;8(1):e2016060.
20. Patel A, Sharma MC, Bakhshi S. Demographic challenges of pediatric NHL: a report on 280 patients. Indian J Pediatr. 2018 Aug;85(8):697–98.
21. Basudan AM, Althani M, Abudawood M, Farzan R, Alshuweishi Y, Alfhili MA. A comprehensive two-decade analysis of lymphoma incidence patterns in Saudi Arabia. J Clin Med. 2024 Mar 13;13(6):1652.
22. Qureshi A, Patel A, Ajumobi AB. H pylori-negative MALT-associated extranodal marginal zone lymphoma: A comprehensive case report and literature review. J Investig Med High Impact Case Rep. 2024 Jan-Dec;12:23247096241238531.
23. Otrock ZK, Saab J, Aftimos G, Nasr F, Farhat FS, Khairallah S, et al. A collaborative nationwide lymphoma study in Lebanon: incidence of various subtypes and analysis of associations with viruses. Pathol Oncol Res. 2013 Oct;19(4):715–22.
24. Szakács Z, Lal A, Kristensen J, Farkas N, Ritter Z, Kiss S, et al. 90Y-ibritumomab tiuxetan in b-cell non-Hodgkin lymphomas: real-world data from the United Arab Emirates. Adv Radiat Oncol. 2021 Dec 26;7(5):100882.
25. Omoti CE, Nwannadi AI, Obieche JC, Olu-Eddo AN. The epidemiological features of lymphoid malignancies in Benin City, Nigeria: a 15 years study. Pan Afr Med J. 2012;11:10.
26. Chen JJ, Tokumori FC, Del Guzzo C, Kim J, Ruan J. Update on T-Cell lymphoma epidemiology. Curr Hematol Malig Rep. 2024;19(3):93–103.
27. Jalili J, Vahedi A, Danandehmehr A, Aynechi P, Esfahani A, Roosta Y, et al. Subtype distribution of lymphomas in northwestern Iran: a retrospective analysis of 659 cases according to World Health Organization classification. BMC Cancer. 2022 Oct 12;22(1):1059.
28. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan;72(1):7–33.
29. Aladily TN, Khreisat W, Ashukhaibi O, Alkhatib SM, Annab H, Tarawneh MS, et al. The epidemiology of lymphoma in Jordan: a nationwide population study of 4189 cases according to World Health Organization classification system. Hematol Oncol Stem Cell Ther. 2021 Dec;14(4):336–42.
30. Bouzari B, Basi A, Dadkhah S, Panahi M, Mohammadi S. Programmed death 1 (PD-1) expression in relapsing and remitting Hodgkin lymphoma as prognostic factor. Asian Pac J Cancer Prev. 2023 Aug 1;24(8):2829–35.
31. Touma E, Antoun L, Hallit S, Nasr F, Massoud M, El Othman R, et al. Non Hodgkin lymphoma in Lebanon: a retrospective epidemiological study between 1984 and 2019. BMC Public Health. 2021 Dec;21(1):1820.
32. Yoon SO, Suh C, Lee DH, Chi HS, Park CJ, Jang SS, et al. Distribution of lymphoid neoplasms in the Republic of Korea: analysis of 5318 cases according to the World Health Organization classification. Am J Hematol. 2010;85(10):760–4.
33. Yang QP, Zhang WY, Yu JB, Zhao S, Xu H, Wang WY, et al. Subtype distribution of lymphomas in Southwest China: analysis of 6,382 cases using WHO classification in a single institution. Diagn Pathol. 2011 Aug;6:77.
34. Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K, et al. Non-Hodgkin lymphoma in South East Asia: an analysis of the histopathology, clinical features, and survival from Thailand. Hematol Oncol. 2018 Feb;36(1):28–36.
35. Waravita TS, Wijetunge TS, Ratnatunga NVI. Pattern of lymphoma subtypes in a cohort of Sri Lankan patients. Ceylon Med J. 2015 Mar;60(1):13–7.
36. Al-Hamadani M, Habermann TM, Cerhan JR, Macon WR, Maurer MJ, Go RS. Non-Hodgkin lymphoma subtype distribution, geodemographic patterns, and survival in the US: a longitudinal analysis of the National Cancer Data Base from 1998 to 2011. Am J Hematol. 2015 Sep;90(9):790–5.
37. Costas L, Casabonne D, Benavente Y, Becker N, Boffetta P, Brennan P, et al. Reproductive factors and lymphoid neoplasms in Europe: findings from the EpiLymph case-control study. Cancer Causes Control. 2012 Jan;23(1):195–206.
38. Laurent C, Do C, Gourraud PA, De Paiva GR, Valmary S, Brousset P. Prevalence of common non-Hodgkin lymphomas and subtypes of Hodgkin lymphoma by nodal site of involvement: a systematic retrospective review of 938 cases. Medicine (Baltimore). 2015 Jun;94(25):e987.
39. Oertel M, Hering D, Baues C, Kittel C, Fuchs M, Kriz J, et al. Radiation doses to mediastinal organs at risk in early-stage unfavorable Hodgkin lymphoma- a risk stratified analysis of the GHSG HD17 trial. Front Oncol. 2023 May 5;13:1183906.
40. Hoeller U, Borgmann K, Oertel M, Haverkamp U, Budach V, Eich HT. Late sequelae of radiotherapy—the effect of technical and conceptual innovations in radiation oncology. Dtsch Ärztebl Int. 2021 Mar 26;118(12):205–11.
41. Cutter DJ, Schaapveld M, Darby SC, Hauptmann M, van Nimwegen FA, Krol ADG, et al. Risk of valvular heart disease after treatment for Hodgkin lymphoma. J Natl Cancer Inst. 2015;107(4):djv008.
42. Dabaja BS, Hoppe BS, Plastaras JP, Newhauser W, Rosolova K, Flampouri S, et al. Proton therapy for adults with mediastinal lymphomas: the international lymphoma radiation oncology group guidelines. Blood. 2018;132:1635–46.
43. Pepper NB, Oertel M, Kittel C, Kröger KJ, Elsayad K, Haverkamp U, et al. Impact of radiation techniques on lung toxicity in patients with mediastinal Hodgkin’s lymphoma. Strahlenther Onkol. 2021;197(1):56–62.
44. Oertel M, Hölscher P, Hering D, Kittel C, Fuchs M, Haverkamp U, et al. Estimation of mediastinal toxicities after radiotherapy for Hodgkin lymphoma-A normal tissue complication analysis of the HD16/17 Trial by the German Hodgkin Study Group. Cancers (Basel). 2024 Mar 16;16(6):1168.
45. Oertel M, Hering D, Nacke N, Kittel C, Kröger K, Kriz J, et al. Radiation therapy in the German Hodgkin Study Group HD 16 and HD 17 trials: quality assurance and dosimetric analysis for Hodgkin lymphoma in the modern era. Adv Radiat Oncol. 2022;8(3):101169.
46. Jones KS, Webster A, Ntentas G, Brady JL, Mikhaeel NG. Deep inspiration breath-hold for mediastinal lymphoma patients: evaluation of a 5-year service. Tech Innov Patient Support Radiat Oncol. 2022 Apr 9;22:26–9.
47. Liu J, Cui Z, Sun T, Li Z, Lin X, Li C, et al. Dosimetry study of radiation toxicity in young patients with mediastinal lymphoma by the use of an inclined board and deep inspiration breath-holding, under the guidance of an optical surface management system. Int J Radiat Oncol Biol Phys. 2022;114(3S): e351–2.
48. Campbell BA, Hornby C, Cunninghame J, Burns M, MacManus M, Ryan G, et al. Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy. Ann Oncol. 2012;23(5):1259–66.
49. Frechette KM, Lester SC, Taparra K, Breen WG, Martenson JA, Hoppe BS, et al. Outcomes of patients with stage I-II Hodgkin lymphoma who had uniform pre-treatment staging with PET/CT and treatment with limited field radiation therapy after chemotherapy. Blood Cancer J. 2022 Aug 22;12(8):121.
50. Bouttell J, Fraser H, Goodlad JR, Hopkins D, McKay P, Oien KA, et al. Adding a gene expression profile test to aid differential diagnosis and treatment in aggressive large B-cell lymphoma: an early exploratory economic evaluation. Appl Health Econ Health Policy. 2024 Mar;22(2):243–54.
51. Murray L, Sethugavalar B, Robertshaw H, Bayman E, Thomas E, Gilson D, et al. Involved node, site, field and residual volume radiotherapy for lymphoma: a comparison of organ at risk dosimetry and second malignancy risks. Clin Oncol (R Coll Radiol). 2015 Jul;27(7):401–10.
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Jul 15, 2025
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Reviewing of radical radiotherapy to the mediastinum in patients with lymphoma. Iraqi Natl J Med [Internet]. 2025 Jul. 15 [cited 2025 Aug. 15];7(2):166-75. Available from: https://iqnjm.com/index.php/homepage/article/view/274
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Author Biography
Zeina Abd-Aljabbar Mahdi Jaber, Baghdad Radiation Oncology and Nuclear Medicine Hospital, Baghdad Medical City, Baghdad, Iraq
.