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How High Can We Go - How Low Should We Aim? Normal Tissue Dose/Volume Constraints in Lymphoma Radiation Therapy Planning
Normal tissue dose-volume constraints are commonly used for lymphoma radiation therapy (RT) planning. However, because the prescribed doses for lymphomas vary significantly depending on histologic subtype and are much lower than for solid tumors, and because the variation in location and extent of disease make the target volumes highly variable, the usual dose-volume constraints known from RT of solid tumors are generally not appropriate for lymphomas. Questions regarding the right constraints are frequently asked by radiation oncologists and dose planners, and the issue is not well covered by present RT guidelines. The ALARA principle to keep doses to all organs at risk “as low as reasonably achievable” does not provide a practical solution, partly because it is not clear what “reasonably achievable” means in the individual patient. In this activity we: 1. Review the factors to consider when using constraints in modern lymphoma RT planning, including the lymphoma subtype, the extent and location of the disease, the response to systemic therapy if given, and the patient’s age, gender, risk factors, co-morbidities and socio-economic status. 2. Review the constraints aimed at avoiding second malignancies and cardiac sequelae, the two most commonly considered long-term side effects of lymphoma RT. 3. Review the dose/response data and propose constraints for other normal tissues which are less often considered in RT planning, but which may nevertheless be clinically important. 4. Discuss the daily practice in different clinical scenarios, including re-irradiation in the relapse setting.
Topics:
- Constraints in Modern Lymphoma Radiotherapy Planning
Lena Specht, MD, DMSc. - Dose/Response Data and Proposed Dose Constraints for Normal Tissue Effects Other than Second Malignancies and Heart Disease
Mario Levis, MD, PhD - Constraints in Different Scenarios in the Daily Lymphoma Practice, including Reirradiation in the Relapse Setting
Chelsea C. Pinnix, MD, PhD - Q and A
Shunan Qi, MD – Moderator
Full Panel
This activity is available from July 1, 2025, through 11:59 p.m. Eastern time on June 30, 2027.
The content was originally presented and recorded at the 2024 ASTRO Annual Meeting.
Target Audience
The activity is designed to meet the interests of radiation oncologists, physicists, dosimetrists and residents.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Explain the factors to consider when deciding dose constraints for RT planning of lymphomas.
- Use the available dose/response data for normal tissues to select appropriate and practical dose constraints in individual lymphoma patients.
- Lena Specht, MD, DMSc., is employed by Rigshospitalet, Copenhagen and the Institute of Clinical Medicine. Dr. Specht receives honoraria from Kyowa Kirin Co. Ltd. Dr. Specht receives grant research funding from Varian, ViewRay and the Danish Cancer Society. Dr. Specht serves as Vice-Chairman of the International Lymphoma Radiation Oncology Group; is a Board Member of the Danish Lymphoma Group; and is Chair of the Danish Lymphoma Radiation Oncology Group.
- Shunan Qi, MD, is employed by National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
- Mario Levis, MD, PhD, is employed by University of Torino, Italy.
- Chelsea C. Pinnix, MD, PhD, is employed by The University of Texas MD Anderson Cancer Center. Dr. Pinnix receives grant/research funding from Merck and serves an uncompensated role with Lancet Haematology as a member of the International Advisory Editorial Board. Dr. Pinnix serves as a DEI Task Force member with the Society of Immunotherapy of Cancer; is radiation oncology chair of the myeloma committee with SWOG; is Co-Chair of the NRG Hematologic Malignancies Core Working Group; is a steering committee member of the International Lymphoma Radiation Oncology Group; and serves as an NRG representative on the National Cancer Institute Lymphoma Steering Committee.
The person(s) above served as the developer(s) of this activity. Additionally, the ASTRO Education Committee had control over the content of this activity. All relevant financial relationships have been mitigated.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.00 Certificate of AttendanceThis activity was designated for 1.00 AMA PRA Category 1 Credit™.
Price
Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.
- Nonmember: $149
- Member: $99
- Member-in-Training: $49
- Student/Graduate Student/PGY-1 Member: $49
- Postdoctoral Fellow Member: $49
If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.
Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date.
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The activity and its materials will only be available on the ASTRO website until June 30, 2027, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date.
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