Consolidative radiotherapy after immuno-chemotherapy in localized bulky diffuse large B-cell lymphoma (DLBCL) patients significantly improves both, overall and progression-free survival and treatment is in principle curative. Therefore protection of organs at risk is highly relevant.
Two 53-years and 18-years old patients with bulky mediastinal DLBCL were planned with and without deep inspiration breath-hold (DIBH) and volumetric modulated arc therapy (VMAT). DIBH reduced the doses to the heart and the lungs while homogeneity and conformity were not compromised. The number of Monitor Units (MU) needed was significantly reduced by DIBH-VMAT. Both patients were treated in DIBH-VMAT.
Planning with DIBH in bulky mediastinal DLBCL is feasible and should be taken into account due to the high relevance with regard to acute and late toxicity.