Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;11(12):e951-e958.
doi: 10.1016/S2352-3026(24)00276-X. Epub 2024 Sep 30.

Radiation target nomenclature for lymphoma trials: consensus recommendations from the National Clinical Trials Network groups

Omran Saifi  1 , Chelsea C Pinnix  2 , Leslie K Ballas  3 , Chris R Kelsey  4 , Sarah A Milgrom  5 , Stephanie A Terezakis  6 , Nicholas B Figura  7 , Rahul R Parikh  8 , John C Grecula  9 , Stella Flampouri  10 , Chul S Ha  11 , Andrea C Lo  12 , John P Plastaras  13 , David C Hodgson  14 , Bradford S Hoppe  15
Affiliations

Radiation target nomenclature for lymphoma trials: consensus recommendations from the National Clinical Trials Network groups

Omran Saifi et al. Lancet Haematol. 2024 Dec.

Abstract

Contemporary lymphoma radiation target volumes that rely on post-systemic therapy imaging do not have standardised nomenclature. A forum of radiation oncology lymphoma leaders from the National Clinical Trials Network groups (NRG Oncology, Children's Oncology Group, SWOG Cancer Research Network, Alliance for Clinical Trials in Oncology, Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group, and the Canadian Cancer Trials Group) was convened and established standardised nomenclature for these volumes in the autumn of 2024. Involved-site radiotherapy includes the full cranial-caudal extent of prechemotherapy disease and takes into account axial anatomical changes only. Residual site radiotherapy targets only the postchemotherapy CT-anatomical mass. PET-directed radiotherapy exclusively targets PET-positive disease and includes three types: PET-directed involved site radiotherapy using the superior-inferior aspect of prechemotherapy involved disease sites that remain PET-avid on post-treatment imaging; PET-directed residual site radiotherapy using only the postchemotherapy CT-anatomical residual mass that contains the PET-avid lesion on post-treatment imaging, without excluding sites that had complete metabolic response; and PET-directed residual PET radiotherapy using only the PET-avid focus, irrespective of the corresponding adjacent non-PET-avid CT-anatomical disease surrounding it.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests LKB declares (in the last 36 months) payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing, or educational events as visiting professor at University of Pittsburgh and Columbia University; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, for the American Board of Radiology as Oral Boards chair Hematology. SF declares (in the last 36 months) payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing, or educational events as visiting professor at University of Kansas; participation on the Proton Collaborative Group Data Safety Monitoring Board; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as chair of Task Group Number 427 Technical Guidelines for the Use of Proton Therapy in Clinical Trials, for the American Association of Physicists in Medicine. JCG reports (without time limit) research in this publication was supported by the National Cancer Institute of the US National Institutes of Health, under award number U10CA180821 (to the Alliance for Clinical Trials in Oncology). JCG declares (in the last 36 months) grants or contracts from Intra-op Medical as institutional support for clinical trial; honorarium payments from DAVA Oncology and Primo-Oncology; support for travel paid by Alliance for Clinical Trials in Oncology to attend their group meeting as the Publication Committee co-chair; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as Publications Committee co-chair at Alliance for Clinical Trials in Oncology, president and immediate past president, and a member of the board of directors at the International Society of Intraoperative Radiation Therapy, president and past president; is a councillor at the Ohio Radiological Society, Small Cell Lung Cancer Guideline, and a committee member at National Comprehensive Cancer Network. CSH declares (in the last 36 months) leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, as chair of the Radiation Oncology Committee at SWOG since June, 2023. BSH declares (in the last 36 months) leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, as NRG Hematologic Working Group co-chair; and travel support to semi-annual meetings from the Children's Oncology Group. SAM declares (in the last 36 months) support for travel to Children's Oncology Group meetings paid for by the Children's Oncology Group, and travel to a National Comprehensive Cancer Network guidelines meeting paid for by the National Comprehensive Cancer Network; leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid, as Children's Oncology Group Hodgkin Lymphoma Committee radiation oncology/imaging lead, American Radium Society Appropriate Use Criteria–Lymphoma chair, and a member of the International Journal of Radiation Oncology, Biology, Physics editorial board. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Hodgkin lymphoma female patient with 2 PET-avid disease sites (Blue-colored masses in the neck and mediastinum). Only CT imaging is utilized which shows residual CT-anatomic disease following systemic therapy in the neck and mediastinum (gray-black masses). Involved-site radiotherapy (ISRT) volume will include and follow the superior-inferior aspect of the pre-systemic therapy disease from the neck to the mediastinum, regardless of CT or PET response. Residual site radiotherapy (RSRT) volume is based on disease CT-response and will only include the residual CT-anatomic disease, independent of PET response, without following the superior-inferior aspect of the pre-systemic therapy disease.
Figure 2.
Figure 2.
Hodgkin lymphoma female patient with 2 PET-avid disease sites (Blue-colored masses in the neck and mediastinum). PET-CT imaging is utilized and shows, following systemic therapy, complete metabolic response in the neck with non-PET avid residual CT-anatomic mass (gray-black mass), and partial metabolic response in the mediastinum with small residual PET-avid focus (blue mass) on top of a larger non-PET avid residual CT-anatomic mass (gray-black mass). PET-directed involved-site radiotherapy (pISRT) volume will include and follow the superior-inferior aspect of the mediastinal pre-systemic therapy disease as it remained with PET-avidity. PET-directed residual site radiotherapy (pRSRT) will only include the PET-avid mediastinal CT-anatomic disease and will not cover the non-PET avid CT-anatomic neck disease. PET-directed residual PET radiotherapy (pRPRT) will only include the PET-avid focus and will not include the corresponding/adjacent non-PET avid CT-anatomic disease.
Figure 3.
Figure 3.
Female patient with large mediastinal early-stage HL who had residual PET-avid mediastinal disease (Deauville 4) on the interim and end-of-systemic therapy PET scans. ISRT (blue contour) would target the whole region that had the initial pre-systemic therapy disease. pRSRT (green contour) would target the CT-anatomic residual mass on end-of-systemic therapy PET-CT and simulation CT scans that is harboring the PET-avidity and would NOT extend superiorly-inferiorly to cover areas where the initial disease was previously located but is no longer present. pRPRT (violet contour) would target only the PET-avid focus on the end-of-systemic therapy PET without including any of the residual CT-anatomic disease that is not PET-avid. ISRT = Involved-site radiotherapy; pRSRT = PET-directed residual site radiotherapy; pRPRT = PET-directed residual PET radiotherapy; Dark blue contour = ISRT clinical tumor volume; Light blue contour = ISRT planning tumor volume; Light green contour = pRSRT clinical tumor volume; Dark green contour = pRSRT planing tumor volume; Violet contour = pRPRT clinical tumor volume; Purple contour = pRPRT planning tumor volume. Red contour = heart; pink contour = breasts.
See this image and copyright information in PMC

References

    1. Kaplan HS, Rosenberg SA. Extended-field radical radiotherapy in advanced Hodgkin’s disease: short-term results of 2 randomized clinical trials. Cancer Res. 1966;26(6):1268–76. - PubMed
    1. Marks JE, Pinsky SM, Griem ML. The extended mantle field in the radiotherapeutic treatment of malignant lymphoma. Radiology. 1971;100(2):423–5. - PubMed
    1. Lowry L, Smith P, Qian W, Falk S, Benstead K, Illidge T, et al. Reduced dose radiotherapy for local control in non-Hodgkin lymphoma: a randomised phase III trial. Radiother Oncol. 2011;100(1):86–92. - PubMed
    1. Yahalom J, Mauch P. The involved field is back: issues in delineating the radiation field in Hodgkin’s disease. Ann Oncol. 2002;13 Suppl 1:79–83. - PubMed
    1. Wirth A, Mikhaeel NG, Aleman BMP, Pinnix CC, Constine LS, Ricardi U, et al. Involved Site Radiation Therapy in Adult Lymphomas: An Overview of International Lymphoma Radiation Oncology Group Guidelines. Int J Radiat Oncol Biol Phys. 2020;107(5):909–33. - PubMed

Publication types