Multimodality Imaging Based Target Definition of Cervical Lymph Nodes in Precise Limited Field Radiation Therapy (Lfrt) for Nodular Lymphocyte Predominant Hodgkin Lymphoma (Nlphl)

Abstract

Hodgkin lymphoma is a rare subtype of B cell lymphoma [1]. Nodular lymphocyte predominant hodgkin lymphoma (NLPHL) constitutes a distinct and typically indolent subtype of hodgkin lymphoma with favorable therapeutic outcomes [2-5]. Radiation therapy (RT) plays a major role in management of NLPHL. However, active surveillance has even been considered as an initial management strategy for selected patients given the typically indolent disease course and concerns regarding treatment induced toxicities [6]. In the context of RT, several studies have addressed use of different approaches for improving the toxicity profile of irradiation such as dose deescalation and limited field RT (LFRT) [7-12]. Irradiation of limited treatment volumes may serve as a viable method in the context of reduced adverse effects, however, this strategy should be utilized carefully with accurate and precise target definition to avoid any geographical misses which may lead to treatment failure. RT planning for NLPHL is typically based on computed tomography (CT) simulation at treatment position. Incorporation of additional imaging modalities offer great potential for improved target definition. Herein, we assess multimodality imaging based target definition of cervical lymph nodes in precise LFRT for NLPHL.