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Table 1 Main dosimetric findings from studies comparing 3D-CRT vs. IMRT

From: Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin’s lymphoma involving the mediastinum

 Heart AP-PAHeart 3D-CRTHeart IMRTLAD AP-PALAD 3D-CRTLAD IMRTLung AP-PALung 3D-CRTLung IMRTBreast AP-PABreast 3D-CRTBreast IMRTThyroid AP-PAThyroid 3D-CRTThyroid IMRT
Goodman et al 2005 [19]: 11 pts HL and 5 pts NHL; 18–45 Gy (median 36 Gy). IMRT: 3–6 beamsMD 19.1
Dmax 35.4
MD 19.3
Dmax 36.2
MD 16.5
Dmax 37.2
   MD 16.7
V20 51
MD 16.2
V20 68
MD 13.7
V20 64
      
Girinsky et al 2006 [20]: 12 pts HL with residual disease; 2/40 Gy IMRT: 5 beams, different anglesMeD 7.8
V30 24.7
MeD 9,1
V30 19.7
MeD 7.7
V30 14
MD 33MD 32MD 30MD 11.2
V20 24.7
MD 14
V20 27.5
MD 12.8
V20 24.5
MeD 0.3
V20 4.8
V5 8
MeD 0.7
V20 4.2
V5 17
MeD 1.2
V20 3.5
V5 26
   
Nieder et al 2007 [21]: IMRT: 7-field coplanar
2/30 Gy
Med 0.1–30; V30 2–46; V7.5 27–94; V4.5 29–96Med 0.1–18.6; V30 4–20; V7.5 26–93; V4.5 31–96Med 0.1–12.6; V30 4–9; V7.5 20–67; V4.5 25–80Med 23.4–28.5; V30 0–90; V7.5 69–100Med 21.3–28.5; V30 0–23; V7.5 72–100Med 11.1–15.9; V30 0–3; V7.5 70–88Right-left: MD 1.5–2.4; V20 24–32; V30 15–20Right-left MD 16.2–16.2; V20 20–26; V30 8–11Right-left MD 13.8–13.2; V20 23–27; V30 3–6Right:MeD 0.9, V25 5, V5 12. Left: MeD 0.9, V25 7, V5 15Right: MeD 1.5, V25 19, V5 46.
Left: MeD 1.5, V25 24, V5 48
Right: MeD 5.1, V25 1, V5 100.
Left: MeD 4.8, V25 1, V5 100
   
Chera et al 2009 [22]: nine stage II HL; INRT 2/30 Gy.
IMRT: 5 equally spaced beams
      MD 4.8
V4 20.7
V10 15.3
V20 11.2
V30 6.2
 MD 5.4
V4 37.5
V10 21.1
V20 6.8
V30 0.8
MD 1.9
V4 7.9
V10 6.5
V24 3.6
V30 0.8
 MD 3.7
V4 25.3
V10 16.8
V24 1.6
V30 0.3
MD 7.1
V4 28.2
V10 21
V24 14
V30 5.3
 MD 9.1
V4 44.6
V10 34.4
V24 15.9
V30 4.6
Cella et al 2010 [23]: 10 pts supra-diaphragmatic HL; 1.5/30 Gy.
Forward planned IMRT
MD 21.2
Dmax 32.3
 MD 21.8
Dmax 32.4
   MD 16.5
V20 45.4
V30 28.5
 MD 16.2
V20 45.1
V30 23.4
MD 8.9
V20 21.2
Dmax 34.2
 MD 7.4
V20 20.7
Dmax 33
MD 27.7
V30 79
Dmax 33.3
 MD 25.3
V30 20.8
Dmax 30.8
Weber et al [24]: 10 early-stage supra-diaphragmatic HD female patients; 2/30 Gy IFRT vs INRT
IMRT: 9 equally-spaced beams vs Rapidarc
       IFRT-INRT
MD 9.1–9.1; V3 46.7–33.3;
V10 33.2–21.5
IFRT-INRT
MD 8.5/8.3–6.9/ 6.5; V3 67.4/67.7–57.9/ 18.8;
V10 34.2/31.4–25.9/ 3.7
 IFRT-INRT
MD 4.9–2.5; V3 6.6–2.9;
V10 3.9–1.5
IFRT-INRT
MD 2.9/2.9–1.6/1.5; V3 25.1/24.1–14.2/13.6;
V10 9.2/6.6–3.5/2.2
 IFRT-INRT
MD 22.6–15.2; V3 91.7–67.5;
V10 83.5–49.4
IFRT-INRT
MD 23.7/23.3–17.5/16.8; V3 90.8/ 91.7–84.1/ 84.3; V10 88.2/85.8–74.3/65.1
Hoppe et al 2012 [25]: 12 pts St I-III HL; 1.8/30.6–39.6 Gy. IMRT: 5–7 beams coplanar or non-coplanar MD 19.4; V4 79.1;V10 70.5; V20 56.5; V30 38.1MD 12.2; V4 70.6; V10 47.4; V20 28.1; V30 13.6    MD 13.2; V4 56.2; V10 44.6; V20 34.9; V30 21.6MD 10.6; V4 65.4; V10 41.4; V20 19.9; V30 3.6 MD 5.4; V4 23.3; V10 18.8; V20 13.3; V30 8.5MD 5.5; V4 37.4; V10 21.8; V20 8.5; V30 0.8 MD 18.8; V4 77.5 V10 62.4 V20 53.5 V30 25.8MD 19.3; V4 98.8 V10 78.5 V20 49.8 V30 11
Koeck et al 2012 [26]: 20 pts (10 M, 10 F) early mediastinal HD; dose 2/30 Gy. IF vs IN. Coplanar IMRT MD 17.9–9.2; V4 74.8–39.5; V10 66.9–32.6, V25 49.6–21.7MD 13.8–7.4; V4 94.2–50.4, V10 61.7–27.8; V25 12.4–6.7    MD 10.6–8.6; V10 37.7–30.2; V20 27.8–21.9DM 12.8–9.6; V10 58.5–39.7; V20 16–11.3 DM 4.4–3.4; V4 22.6–17.1; V10 17.1–13; V25 3.8–3.3DM 6–4.6; V4 61.8–38.6, V10 15.8–13.7, V25 0.8–0.6   
Campbell et al 2012 [27]: 10 females, stage I–IIA supra-diaphragmatic HL. INRT 1.8/30.6 Gy. IMRT: VMAT MD 6.9; V30 11.1MD 4.3; V30 1.6 MD 25MD 24.7 MD 7.3; V5 28.1; V20 18.6MD 6.9; V5 45.3; V20 8.1 MD 1.6; V5 6.1; V20 3.3MD 2.1; V5 19.6; V20 0.2 MD 13.5; V4 53.4; V20 37.9MD 15.5; V4 75; V20 37.7
De Sanctis et al 2012 [28]: 10 supra-diaphragmatic St. II HL. IFRT 2/30 Gy. IMRT: 5 equally spaced beams. MD 4.3; V5 15.8; V10 12.9; V20 7.6; V30 1.3MD 4.2; V5 25.7; V10 15.3; V20 6.5; V30 0.2 MD 9.9; V5 44; V10 39.2; V20 25.7; V30 6.2MD 9; V5 52.8; V10 44.5; V20 23; V30 0.9 MD 6.8; Left-Right: V5 28.9–30.3; V10 20.5–23.2; V20 13.2–14.7; V30 4.7–2.6MD 8.7; Left-Right: V5 48.1–44.8; V10 30–32.8; V20 7.8–7.9; V30 0.1–0.1 MD 1; Left-Right: V5 4.1–3.3; V10 2.1–1.7; V20 1.1–0.9; V30 0.2–0.8MD 2.3; Left-Right: V5 20.6–17; V10 13.6–11; V20 0–0; V30 0–0 MD 15.3; V10 64.8; V20 46.4; V30 16.2MD 21.4; V10 95; V20 54.6; V30 9.6
Fiandra et al 2012 [29]: 10 female mediastinal HL patients. INRT 2/30 Gy. IMRT: VMAT vs TD vs HT MD 5.1MD 3.1–4.3 MD 22.1; V20 73.5MD 15.7–19.8; V20 43.1–59.1 MD 6.6; V5 29.3; V10 22.6; V20 15.2; V30 3.5MD 5.9–6.4; V5 26.4–39; V10 20.6–25.6; V20 7.6–15.6; V30 0.1–0.7 MD 1 Gy, V4 4.5; V10 2.5; V20 0.9; V30 0.2MD 0.7–1.2; V4 3.7–6.2; V10 1.1–2.4; V20 0.1–1.3; V30 0–0.6 MD 17.7; V18 45.9; V25 32MD 13.5–17.3; V18 33.4–51.3; V25 21.3–32.9
Chen et al 2012 [30]: 19 pts mediastinal HD or NHL; dose 2/36 Gy.
IMRT. Coplanar vs non-coplanar
MD 17; V30 34.5 MD 14.5–15, V30 22.4–22.1   MD 13.3; V5 50, V10 42.5 V20 32.2 MD 13.8–12.9; V5 61.2–53.9; V10 48–43.2; V20 27.9–26.9MD 2.8; V5 12, V10 8.1, V20 6.4 MD 3.3–2.9; V5 16%, V10 8.4–8, V20 4–4   
Cella et al 2013 [31]: three PTV scenarios, supra-diaphragmatic HD. 1.5/30 Gy.
IMRT: forward, inverse or Tomo
V25 22.5–60.5 V25 from 21 to 4.5 to 8.7–67.5   V20 12.1–30.7; MD 5.3–11.9 V20 from 15 10.1–15 to 23–28.8;
MD from 4.9–8.1 to 11.1–13.5
   V30 49–93.9 V30 from 16.9–48 to 45–60
Antoni et al 2013 [32]: 13 pts supradiaphragmatic St. II HL. INRT 2/30 Gy + 2/6 Gy boost. IMRT: Helical Tomotherapy MD 13; V20 32.2; V30 23.1MD 11.2; V20 20.7; V30 11.1    MD 12; V5 47.1; V20 28.2; V30 19.4MD 9.2; V5 56.4; V20 12.2; V30 4.9 MD 2.7; V5 27; V20 5.7; V25 5.1; V30 4.1MD 4.7; V5 9.9 V20 3.9; V25 1.2; V30 0.2 MD 34.6; V30 87.7MD 31.6; V30 72.7
Maraldo et al 2013 [7]: 27 patients, St I-II supra-diaphragmatic HL. INRT 1.8/30.6 Gy. IMRT: VMAT MD 9.9MD 10.1    MD 8.6MD 11.4 MD 3.0MD 7.5   
Voong et al 2014 [33]: 9 female pts with mediastinal HL; INRT 1.8/30.6 Gy.
IMRT: butterfly, multiple arcs
MD 14.3
V30 29
V20 38.8
V5 46
 MD 11.5
V30 16.8
V20 28.3
V5 42.5
MD 14.5 V30 28.5 V20 42.2 V5 51.7 MD 10.4 V30 21.5 V20 28
V5 51.8
MD 11.3 V30 19.5 V20 29.9 V5 41.1 MD 9.3
V30 4.8 V20 22.2
V5 54
Right: MD 1.9, V30 1.9,V20 3.7, V5 7.5. Left: MD 2.4, V30 2.9,V20 4.9, V5 8.4 Right: MD 2.3, V30 0.5, V20 3.8, V5 13.7.
Left: MD 2.4, V30 1.2, V20 4, V5 11.2
   
Aznar et al 2015 [34]: 22 pts early-stage mediastinal HL; INRT 1.8/30.6 Gy free breath vs breath hold; IMRT: different techniques FB vs DIBH
MD: 8.7–5.4; V20 19.8–14.5
FB vs DIBH
MD: 8.1–4.5; V20 15.7–7.9
    FB vs DIBH
MD: 10.3–8.2; V20 20.8–20.7
FB vs DIBH
MD: 9.8–8.2; V20 17.9–13.7
 FB vs DIBH
MD: 2.3–3.2
FB vs DIBH
MD: 4.2–4.8
 FB vs DIBH
MD: 22.1–25.9
FB vs DIBH
MD: 25.4–28.2
Kriz et al 2015 [35]: 11 pts mediastinal early HL; 1.8/30.6 Gy INRTvs IFRT, DIBH vs free breath. IMRT: 5 beams vs 7 equally spaced beams.MD 4–12.6 MD 4.1–15.4   MD 5.9–9.1; V10 18.3–32.6; V20 14.1–25.4 MD 6.5–13; V10 25.8–57.8; V20 9.5–24.1Left: MD 2–4.5; Right: 0.6–1.5 Left: MD 2.4–7.4; Right: 1.2–5.5   
Besson et al 2016 [36]: 69 pts with HL or NHL; doses calculated for 2/30 Gy. IMRT: TomotherapyMD 11.7 MeD 8.4 V4 45
V20 34.1 V30 16.6
 MD 9
MeD 7
V4 51.2 V20 18.6 V30 3.4
   MD 9.6 MeD 8.7 V4 42.4
V20 25.6 V30 9.8
 MD 9.5 MeD 11.1 V4 62
V20 16.2 V30 2.3
      
Horn et al 2016 [37]: 14 females with stage II mediastinal HL. ISRT 2/30 Gy. IMRT: Tomotherapy MD 11.3; Dmax 30.9; V4 41.8; V10 36.7; V20 31.1; V30 11.8MD 8.5; Dmax 30.8; V4 46.2; V10 33.8; V20 23.4; V30 10.1    Left-Right MD 9.4–7.5; V4 41.3–33.6; V10 31.7–24.7; V20 25.4–18.6; V30 10.1–6.5Left-Right MD 8.6–7.8; V4 56.4–55.2; V10 36.2–30.8; V20 13.8–12; V30 0.3–0.7 Left MD 5.6; V4 22.8; V10 18.6; V20 14.6; V30 4.9 Right MD 3.6; V4 14.8Left MD 4.9; V4 36; V10 19.9; V20 4.2; V30 0.2 Right MD 3.8; V4 33.4   
Higby et al 2016 [38]: 11 pts HL st. I-II; ISRT 1.8/30.6–36 Gy.
IMRT: VMAT
 MD 15.8 V30 24.7MD 12.8 V30 17.7    MD 13 V20 35.4
V5 52.6
MD 11.9 V20 20.8 V5 67.8 Left:V5 5.3, V10 4.5
Right: V5 4.6, V10 1.3
Left: V5 39.5, V10 17.7
Right: V5 32.4, V10 11.2%.
   
  1. Abbreviations: MD mean dose, MeD median dose, V volume