S510
Clinical - Haemotology
ESTRO 2026
Conclusion: VMAT achieved considerably lower mean dose to kidneys and lungs compared with IMRT at extended SSD - while retaining the same PTV coverage. References: [1]Hui C, Simiele E, Lozko Y, Romero I, Skinner L, Binkley MS, et al. Volumetric modulated arc therapy total body irradiation improves toxicity outcomes compared to 2D total body irradiation. Front Oncol 2024;14:1459287. [2]Fog LS, Hansen VN, Kjær- Kristoffersen F, Berlon TE, Petersen PM, Mandeville H, et al. A step and shoot intensity modulated technique for total body irradiation. Tech Innov Patient Support Radiat Oncol 2019;10:1–7. [3]Ngo N, Blomain ES, Simiele E, Romero I, Hoppe RT, Hiniker SM, et al. Improved organ sparing using auto - planned Stanford volumetric modulated arc therapy for total body irradiation technique. Pediatr Blood Cancer 2023;70:e30589. Keywords: TBI, VMAT, pediatric Breath-Hold in Mediastinal Lymphoma Radiotherapy: Techniques, Feasibility, and Dosimetric Benefits - A Systematic Review Gyanne G.A. Tholen, Bastiaan D.P. Ta, Ruud Houben, Richard Canters, Maaike Berbée Department of Radiation Oncology (Maastro), GROW - Research Institute for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands Purpose/Objective: Patients with early stage mediastinal lymphoma are treated with (immuno)chemotherapy followed by radiotherapy. Prognosis for this relatively young patient group is favourable, with a progression-free survival of up to 98%. However, long-term survival may be influenced by late treatment-related side- effects. Lower doses to organs of interest are associated with a decreased risk of side-effects in mediastinal lymphoma patients [1, 2, 3]. Radiotherapy during breath-hold reduces dose to organs of interest. This work aims to provide a comprehensive overview of the (supportive) breath-hold techniques used, their feasibility, and their dosimetric benefits. Material/Methods: A systematic review was conducted using the PRISMA guidelines to identify and evaluate studies using Digital Poster 2831 breath-hold techniques during mediastinal lymphoma radiotherapy. The main objectives were:To identify and describe the different techniques used to support and monitor breath-hold in clinical practice.To compare the reported advantages and disadvantages of these techniques, including patient compliance,
reproducibility, and feasibility.To quantify the dosimetric benefits of breath-hold in terms of OAR dose reduction.A comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar using a broad/comprehensive search. Data extraction included study design, patient population, breath-hold method, monitoring technique, implementation rate, and quantitative OAR dose comparisons. The results were synthesized narratively, focusing on clinical feasibility, technological setup, and dose reduction potential. Results: Forty-three studies (containing 1,149 patients) were included in the systematic review with varying methodological quality (Figure 1). Breath-hold was assessed in both proton and photon settings. A wide range of photon techniques (e.g. VMAT, IMRT, 3D-CRT) was used. Breath-hold was most often performed in deep-inspiration breath-hold (DIBH) (95%), which significantly reduced the mean heart and lung doses (both 0.62 Gy; 95% CI: 0.47-0.77 and 0.48-0.77, respectively) compared to free-breathing (Figures 2A- B). Mean breast dose(s) did not significantly differ. A dose reduction was observed in the left-anterior descending artery with DIBH (0.29 Gy, 95% CI: 0.04- 0.54). Limited data was available on patient setup, use of feedback or machine-assisted techniques, and whether or not DIBH had been implemented.
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