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The impact of involved node, involved field and mantle field radiotherapy on estimated radiation doses and risk of late effects for pediatric patients with Hodgkin lymphoma.
[hodgkin lymphoma, classical]
The
use
of
radiotherapy
(
RT
)
is
debated
for
pediatric
patients
with
Hodgkin
lymphoma
(
HL
)
due
to
the
late
effects
of
treatment
.
Radiation
doses
to
the
thyroid
,
heart
,
lungs
,
and
breasts
are
compared
with
the
extensive
mantle
field
(
MF
)
,
Involved
Field
RT
(
IFRT
)
,
Modified
IFRT
(
mIFRT
)
,
and
Involved
Node
RT
(
INRT
)
and
the
risk
of
radiation-induced
cardiovascular
disease
,
secondary
cancers
,
and
the
corresponding
Life
Years
Lost
(
LYL
)
is
estimated
with
each
technique
.
INRT
,
mIFRT
,
IFRT
,
and
MF
plans
(
20
and
30
Gy
)
were
simulated
for
10
supradiaphragmatic
,
clinical
stage
I
–
II
classical
HL
patients
<
18
years
old
,
total
of
4
x
2
plans
for
each
patient
.
The
lifetime
excess
risks
of
cardiac
morbidity
,
cardiac
mortality
,
lung
,
breast
,
and
thyroid
cancer
with
each
technique
were
estimated
.
The
estimated
excess
risks
attributable
to
RT
were
based
on
HL
series
with
long
-term
follow-up
,
treating
death
from
other
causes
as
competing
risks
.
The
corresponding
LYL
were
derived
from
the
estimated
excess
risks
.
Statistical
analyses
were
performed
with
repeated
measures
ANOVA
.
B
oth
a
reduction
in
field
size
and
in
prescribed
radiation
dose
significantly
lowered
the
estimated
dose
to
the
heart
,
lungs
,
breasts
,
and
thyroid
compared
to
past
,
extended
fields
,
even
for
patients
with
mediastinal
disease
.
This
translated
into
a
significantly
reduced
estimated
risk
of
cardiovascular
disease
,
secondary
cancers
,
and
LYL
.
Involved
Node
Radiotherapy
should
be
considered
for
pediatric
patients
with
Hodgkin
lymphoma
since
it
is
estimated
to
substantially
lower
the
risk
of
severe
long
-term
complications
.
Diseases
Validation
Diseases presenting
"in prescribed radiation dose significantly lowered the estimated dose to the heart"
symptom
hodgkin lymphoma, classical
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