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Radiation therapy with inverted-Y field for malignant lymphoma

General

Indications

A standard inverted-Y field covers all paraaortal, iliacal, and inguinal lymph nodes as well as upper femoral nodes. The inverted-Y field originated from the extended field for treating Hodgkin's lymphoma with infradiaphragmal spreading. 

The standard inverted-Y field is seldom used today. Many examples of involved field radiotherapy under the diaphragm are considered parts of an inverted Y field. Fields the size of an inverted-Y field are also considered involved field irradiation in some instances. Like the mantle field, it is therefore advantageous to know the principles of modeling an inverted-Y field.

Curative radiotherapy

  • For localized stages of classical Hodgkin's lymphoma (stage IA/IIA), radiation therapy is given to the original area involved with margin (involved field) after chemotherapy (ABVD or equivalent).
  • For localized stages of nodular lymphocyte-rich Hodgkin's lymphoma (stage IA/IIA) without risk factors, radiation therapy alone is given to the involved area with margin (involved field) without previous chemotherapy.
  • Special guidelines apply for children and adolescents up to 18 years with Hodgkin's lymphoma.
  • For residual tumor of Hodgkin's lymphoma after full chemotherapy for advanced Hodgkin's lymphoma (6-8 ABVD, 8 BEACOPP or equivalent), consolidative radiation therapy to the residual tumor with margin is considered.
  • For localized stages of aggressive lymphomas (stage I-II1), consolidative radiation therapy after chemotherapy (CHOP-based or equivalent) to the original tumor-involved area with margin (involved field) is given.
  • With residual tumor of aggressive lymphomas after full chemotherapy (6-8 CHOP-based cycles or equivalent), consolidative radiotherapy to the

Palliative radiotherapy

  • As palliative radiation therapy, the method is based on guidelines for curative treatment with individual modifications.

     

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