Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group Joachim Yahalom,

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Presentation transcript:

Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group Joachim Yahalom, MD, Tim Illidge, MD, PhD, Lena Specht, MD, PhD, Richard T. Hoppe, MD, Ye-Xiong Li, MD, Richard Tsang, MD, Andrew Wirth, MD International Journal of Radiation Oncology • Biology • Physics Volume 92, Issue 1, Pages 11-31 (May 2015) DOI: 10.1016/j.ijrobp.2015.01.009 Copyright © 2015 The Authors Terms and Conditions

Fig. 1 Primary central nervous system lymphoma in a 70-year-old woman: diffuse large B-cell lymphoma. (A) Magnetic resonance image (MRI) at diagnosis. (B) MRI with complete response after high-dose methotrexate—based chemotherapy. (C, D) Whole brain radiation therapy consolidation with 23.4 Gy. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 2 Dura mater lymphoma in a 29-year-old woman with seizures and 2 foci of dural marginal zone lymphoma (A, B), treated with 24 Gy whole brain radiation therapy (C) followed by 12 Gy involved site radiation therapy to lesions (D). International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 3 Orbital lymphoma in a 58-year-old man with blurry vision. (A) Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography lead to diagnosis of marginal zone lymphoma (MZL) with conjunctiva and choroid involvement. (B) Volumes for intensity modulated radiation therapy: gross tumor volume, choroidal space, and conjunctiva, red; clinical target volume, left orbit, yellow; planning target volume, 5 mm, blue. (C) Alternative approach with conformal superior and inferior oblique wedges (different orbital MZL case). International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 4 (A, B) Lymphoma of the tonsil in a 42-year-old man after right tonsillectomy showing diffuse large B-cell lymphoma of right tonsil alone. (C, D) Received short chemotherapy followed by involved site radiation therapy to tonsil of 30 Gy with intensity modulated radiation therapy; gross tumor volume, red; clinical target volume, yellow; planning target volume, blue. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 5 NK/T cell lymphoma, nasal type. Primary tumor involved the left nasal cavity. Treatment with radiation therapy alone. Clinical target volume covers the bilateral nasal cavity, left maxillary sinus, and anterior ethmoid sinuses but does not include the nasopharynx. Dose distribution; (a) transverse, (b) coronal, (c) sagittal planes. d: dose-volume histogram. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 6 NK/T cell lymphoma, nasal type. Primary tumor involved the bilateral nasal cavity extended into the nasopharynx. Treatment with radiation therapy alone. Clinical target volume covers the bilateral nasal cavity, bilateral maxillary sinuses, anterior ethmoid sinuses, and nasopharynx. a-c: views of transverse plane; d-e: sagittal plane and lateral field; f: Dose-volume histogram. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 7 Breast lymphoma in a 49-year-old woman, with biopsy of right breast showing diffuse large B-cell lymphoma. (A) Fluorodeoxyglucose positron emission tomography before chemotherapy). (B) Consolidation involved site radiation therapy includes the whole right breast to 30 Gy. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 8 Lymphoma of lung in a 62-year-old woman with stage IAE marginal zone lymphoma of lung (bronchial associated lymphoid tissue lymphoma) shown on computed tomography (CT) and fluorodeoxyglucose positron emission tomography (A, B). Plan of involved site radiation therapy for 30 Gy in 15 fractions (C). Gross tumor volume, red; internal target volume, composed of clinical target volume of 1 cm expanded by 4-dimensional CT for respiration; planning target volume (5 mm). International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 9 Mesenteric lymphoma in a 70-year-old man with 3-cm diffuse large B-cell lymphoma. (A, B) Computed tomographic and fluorodeoxyglucose positron emission tomographic images before chemotherapy. (C) Minor residual after chemotherapy. Consolidation involved site radiation therapy volumes: gross tumor volume (GTV) and residual GTV, red; clinical target volume, green; planning target volume, purple. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 9 Mesenteric lymphoma in a 70-year-old man with 3-cm diffuse large B-cell lymphoma. (A, B) Computed tomographic and fluorodeoxyglucose positron emission tomographic images before chemotherapy. (C) Minor residual after chemotherapy. Consolidation involved site radiation therapy volumes: gross tumor volume (GTV) and residual GTV, red; clinical target volume, green; planning target volume, purple. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 10 (A) Gastric lymphoma in a 65-year-old man with gastric marginal zone lymphoma treated with radiation therapy alone for 30 Gy. Clinical target volume (CTV), pink; internal target volume after 4-dimensional computed tomography, light blue; planning target volume, dark blue. (B) Volumes for gastric lymphoma: effect of respiration: CTV at inspiration, yellow; at expiration, pink. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions

Fig. 10 (A) Gastric lymphoma in a 65-year-old man with gastric marginal zone lymphoma treated with radiation therapy alone for 30 Gy. Clinical target volume (CTV), pink; internal target volume after 4-dimensional computed tomography, light blue; planning target volume, dark blue. (B) Volumes for gastric lymphoma: effect of respiration: CTV at inspiration, yellow; at expiration, pink. International Journal of Radiation Oncology • Biology • Physics 2015 92, 11-31DOI: (10.1016/j.ijrobp.2015.01.009) Copyright © 2015 The Authors Terms and Conditions