Abdominal irradiation in non-Hodgkin's lymphomas

Area of Science:

• Radiation Oncology
• Medical Physics
• Clinical Oncology

Background:

• Subdiaphragmatic relapses are common in non-Hodgkin's lymphoma patients treated with standard inverted "Y" radiation portals.
• High local failure rates may stem from excluding mesenteric lymph nodes, liver, and intestines from radiation fields.

Purpose of the Study:

• To describe the incidence of subdiaphragmatic relapses in non-Hodgkin's lymphoma.
• To present a safe and effective whole abdomen radiation technique to improve outcomes.

Main Methods:

• Analysis of 170 patients with non-Hodgkin's lymphoma treated with radiation.
• Description of a modified whole abdomen radiation technique using lead blocks and decubitus lateral fields.
• Dosimetric analysis and anatomical description of lymphatic drainage.

Main Results:

• Standard inverted "Y" portals led to subdiaphragmatic relapses in 29% of 132 patients.
• The modified whole abdomen technique was used in 38 patients since 1973.
• The modified technique involves whole abdomen irradiation with liver shielding, followed by boost doses to para-aortic and mesenteric nodes.

Conclusions:

• The standard inverted "Y" technique has a high failure rate below the diaphragm.
• A modified whole abdomen radiation technique appears safe and effective for treating non-Hodgkin's lymphoma.
• Further evaluation of this technique is warranted to confirm its efficacy and safety profile.