TY - JOUR
T1 - Scrotal Irradiation in Primary Testicular Lymphoma
T2 - Review of the Literature and In Silico Planning Comparative Study
AU - Brouwer, Charlotte L.
AU - Wiesendanger, Esther M.
AU - van der Hulst, Peter C.
AU - van Imhoff, Gustaaf W.
AU - Langendijk, Johannes A.
AU - Beijert, Max
PY - 2013/2/1
Y1 - 2013/2/1
N2 - We examined adjuvant irradiation of the scrotum in primary testicular lymphoma (PTL) by means of a literature review in MEDLINE, a telephone survey among Dutch institutes, and an in silico planning comparative study on scrotal irradiation in PTL.We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D-95% scrotal dose of at least 85% of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95% of the prescribed dose, with lowest maximum dose.Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage. (C) 2013 Elsevier Inc.
AB - We examined adjuvant irradiation of the scrotum in primary testicular lymphoma (PTL) by means of a literature review in MEDLINE, a telephone survey among Dutch institutes, and an in silico planning comparative study on scrotal irradiation in PTL.We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D-95% scrotal dose of at least 85% of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95% of the prescribed dose, with lowest maximum dose.Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage. (C) 2013 Elsevier Inc.
KW - NON-HODGKINS-LYMPHOMA
KW - DOXORUBICIN-BASED THERAPY
KW - LARGE-CELL LYMPHOMA
KW - MALIGNANT-LYMPHOMA
KW - EXTRANODAL LYMPHOMA
KW - PROGNOSTIC-FACTORS
KW - GONADAL-FUNCTION
KW - GROUP EXPERIENCE
KW - NORMAL TISSUE
KW - TESTIS
U2 - 10.1016/j.ijrobp.2012.06.019
DO - 10.1016/j.ijrobp.2012.06.019
M3 - Review article
SN - 0360-3016
VL - 85
SP - 298
EP - 308
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 2
ER -