A Systematic Review on Intensity Modulated Radiation Therapy for Mediastinal Hodgkin's Lymphoma

Background: Secondary malignant neoplasms (SMNs) and cardiovascular diseases induced by chemotherapy and radiotherapy represent the main cause of excess mortality for early-stage Hodgkin lymphoma patients, especially when the mediastinum is involved. Conformal radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) could allow a reduction of the dose to the organs-at-risk (OARs) and therefore limit long-term toxicity. Methods: We performed a systematic review of the current literature regarding comparisons between IMRT and conventional photon beam radiotherapy, or between different IMRT techniques, for the treatment of mediastinal lymphoma. Results and conclusions: IMRT allows a substantial reduction of the volumes of OARs exposed to high doses, reducing the risk of long-term toxicity. This benefit is conterbalanced by the increase of volumes receiving low doses, that could potentially increase the risk of SMNs. Treatment planning should be personalized on patient and disease characteristics. Dedicated techniques such as butterfly VMAT often provide the best trade-off.

Automated summary

IMRT is effective in reducing the dose to OARs in mediastinal lymphoma treatment, which decreases the risk of long-term toxicity. However, there is a trade-off as it may increase the risk of SMNs due to increased low dose volumes, highlighting the importance of personalized treatment planning and selecting appropriate techniques for individual patients and disease characteristics.