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

Michael Oertel; Dominik Hering; Nina Nacke; Christopher Kittel; Kai Kröger; Jan Kriz; Michael Fuchs; Christian Baues; Dirk Vordermark; Rita Engenhart-Cabillic; Klaus Herfarth; Peter Lukas; Heinz Schmidberger; Simone Marnitz; Peter Borchmann; Andreas Engert; Uwe Haverkamp; Hans Theodor Eich

doi:10.1016/j.adro.2022.101169

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 Dec 30;8(3):101169. doi: 10.1016/j.adro.2022.101169. eCollection 2023 May-Jun.

Authors

Michael Oertel¹, Dominik Hering¹, Nina Nacke¹, Christopher Kittel¹, Kai Kröger¹, Jan Kriz², Michael Fuchs³, Christian Baues⁴, Dirk Vordermark⁵, Rita Engenhart-Cabillic⁶, Klaus Herfarth⁷, Peter Lukas⁸, Heinz Schmidberger⁹, Simone Marnitz⁴, Peter Borchmann³, Andreas Engert³, Uwe Haverkamp¹, Hans Theodor Eich¹

Affiliations

¹ Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany.
² Department of Radiation Oncology, Alexianer Clemenshospital Muenster, Muenster, Germany.
³ Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Düsseldorf, University Hospital of Cologne, Cologne, Germany.
⁴ Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany.
⁵ Department of Radiation Oncology, University Hospital Halle (Saale), Halle (Saale), Germany.
⁶ Department of Radiotherapy and Radiation Oncology, University Hospital Giessen-Marburg, Marburg, Germany.
⁷ Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
⁸ Department of Radiooncology, Medical University Innsbruck, Innsbruck, Austria.
⁹ Department of Radiotherapy and Radiation Oncology, University Hospital Mainz, Mainz, Germany.

Abstract

Purpose: Radiation therapy (RT) is an integral part of treatment concepts for early-stage Hodgkin lymphoma. This analysis reports on RT quality in the recent HD16 and 17 trials of the German Hodgkin Study Group (GHSG).

Methods and materials: All RT plans of involved-node radiation therapy (INRT) in HD 17 were requested for analysis, along with 100 and 50 involved-field radiation therapy (IFRT) plans in HD 16 and 17, respectively. A structured assessment regarding field design and protocol adherence was performed by the reference radiation oncology panel of the GHSG.

Results: Overall, 100 (HD 16) and 176 (HD 17) patients were eligible for analysis. In HD 16, 84% of RT series were evaluated as correct, with significant improvement compared with the predecessor studies (P < .001). In HD 17, 76.1% of INRT cases revealed a correct RT design compared with 69.0% of IFRT-cases, which was superior to previous studies (P < .001). Comparing INRT and IFRT, we found no significant differences in the percentage of any deviation (P = .418) or major deviations (P = .466). Regarding dosimetry, INRT was accompanied by an improvement in thyroid doses. Comparing different RT techniques, we found that intensity-modulated RT showed a reduction of high doses in the lung at the expense of an increased low-dose exposure in HD 17.

Conclusions: The latest study generation of the GHSG demonstrates an improved quality in RT. A modern INRT design could be established without deterioration in quality. On a conceptual level, an individual consideration of the appropriate RT technique has to be performed.