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  • Title: Dosimetric evaluation and treatment outcome of intensity modulated radiation therapy after doxorubicin-based chemotherapy for primary mediastinal large B-cell lymphoma.
    Author: Xu LM, Li YX, Fang H, Jin J, Wang WH, Wang SL, Liu YP, Song YW, Liu QF, Chen B, Qi SN, Ren H, Dai JR.
    Journal: Int J Radiat Oncol Biol Phys; 2013 Apr 01; 85(5):1289-95. PubMed ID: 23245279.
    Abstract:
    PURPOSE: The value of intensity-modulated radiation therapy (IMRT) after doxorubicin-based chemotherapy in primary mediastinal large B-cell lymphoma (PMBCL) is unknown. We assessed the dosimetric parameters, treatment outcomes, and toxicity of IMRT in PMBCL. METHODS AND MATERIALS: Forty-one PMBCL patients underwent mediastinal IMRT after doxorubicin-based chemotherapy. Thirty-eight patients had stage I-II disease, and 3 patients had stage III-IV disease. Most patients presented with bulky mediastinal disease (65.9%) and local invasion (82.9%). The dose-volume histograms of the target volume and critical normal structures were evaluated. RESULTS: The average planning target volume (PTV) mean dose was 39 Gy. Only 0.5% and 1.4% of the PTV received <90% and <95% of the prescribed dose, respectively, indicating excellent target coverage. The median mean lung dose and percentage lung volume receiving 20 Gy (V20) were 16.3 Gy and 30.6%. The 5-year overall survival (OS) and local control (LC) were 95.1% and 89.8%. After chemotherapy, consolidation radiation therapy in patients with complete/partial response resulted in significantly better survival than salvage radiation therapy in patients with stable/progressive disease (3-year OS 100% vs 75%; 3-year LC 96.6% vs 62.5%). No grade 4 or 5 acute or late toxicities occurred. CONCLUSIONS: Mediastinal IMRT after doxorubicin-based chemotherapy can be safely and efficiently delivered, and it provides favorable outcomes in PMBCL patients with a large target volume and high-risk features.
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