Clinical intensity-modulated proton therapy for Hodgkin lymphoma: which patients benefit the most?
AffiliationClinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford
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AbstractPURPOSE: Radiotherapy (RT) improves control of Hodgkin lymphoma (HL), but patients undergoing RT are at risk of late effects, including cardiovascular disease and second cancers, due to radiation dose to organs at risk (OAR). Proton therapy (PT) can reduce OAR dose compared to conventional photon RT. However, access to PT is currently limited so referral must be appropriately selective. We aim to identify subgroups of HL patients who could benefit most dosimetrically from RT with PT based on their pre-chemotherapy disease characteristics. METHODS AND MATERIALS: Normal tissue radiation doses were calculated for 21 HL patients treated with deep inspiration breath-hold pencil-beam scanning (PBS) PT and compared to doses from 3D-conformal and partial-arc volumetric modulated (PartArc) photon RT. Pre-chemotherapy disease characteristics associated with significant dosimetric benefits from PBS compared to photon RT were identified. RESULTS: Treatment with PBS was well tolerated and provided with good local control. PBS provided dosimetric advantages for patients whose clinical treatment volume extended below the 7th thoracic level and for female patients with axillary disease. Additionally, an increasing dosimetric benefit for some OAR was observed for increasing target volume. PBS significantly reduced the mean dose to the heart, breast, lungs, spinal cord and esophagus. Dose homogeneity and conformity within the target volume were also superior with PBS but some high dose measures and hot spots were increased with PBS compared to PartArc. CONCLUSIONS: PBS gives good target coverage and local control whilst providing reductions in radiation dose to OAR for individuals receiving RT for HL compared to advanced photon RT. Our findings highlight certain groups of patients who would be expected to gain more dosimetric benefit from PBS. These findings facilitate the selection of patients who should be considered a priority for PT.
CitationNtentas G, Dedeckova K, Andrlik M, Aznar MC, George B, Kubes J, et al. Clinical intensity-modulated proton therapy for Hodgkin lymphoma: which patients benefit the most? Pract Radiat Oncol. 2019 Jan 29.
JournalPractical Radiation Oncology
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