Radiotherapeutic aspects of the treatment of adult patients with supradiaphragmatic Hodgkin's disease CS I/II. Pt. 2

For patients of the low risk group and primary radiotherapy recommended treatment fields are: Regional field for isolated high cervical involvement, mantle field for isolated mediastinal involvement and extended mantle field for the other patients. Details of the mediastinal treatment volume for patients with adjuvant radiotherapy after chemotherapy for bulky mediastinal disease are given. According to some recent analysis of a large body of dose-effect data, the recommended target doses in primary irradiation are between 36 and 40 Gy for regions with proven involvement and between 30 and 36 Gy for electively treated regions. The recommended target dose per fraction is between 1.5 and 1.8 Gy and less than 2 Gy in various critical tissues. According to the recent recommendations, the maximal total doses in mantle field radiotherapy to the spinal cord should be 38 Gy for radiotherapy alone and 36 Gy for radiotherapy combined with chemotherapy. The maximal total dose to the whole heart should be 15 Gy and for the other parts between 30 and 35 Gy. After chemotherapy with MOPP oder MOPP-like regimes, there is a cumulative risk of leukaemia between 2.2 and 11.9%. After radiotherapy alone, there is only a very low risk of leukaemia after radiotherapy and chemotherapy to the risk after chemotherapy. Most long-term studies show an increased risk of solid second malignancies associated with radiotherapy with a relative risk of approximately two. In the analized studies, the cumulative risk of solid second malignancy after seven to 15 years is between 7 and 11.2% after radiotherapy, between 7 and 11.7% after chemotherapy and between 7 and 11.7% after radiotherapy and chemotherapy. After mediastinal radiotherapy with a dose per fraction of less than 2 Gy and a total dose between 30 and 40 Gy to the anterior heart region, three studies show an increase of the risk of ischaemic cardiac events as well as slight thickening of the aortic and/or mitral valves. Hypothyroidism is a frequent sequela of cervical radiotherapy. (orig./MG)