Vital organ sparing with proton therapy for pediatric Hodgkin lymphoma: Toxicity and outcomes in 50 patients. (March 2022)

• Record Type: Journal Article
• Authors: Tringale, Kathryn R.; Modlin, Leslie A.; Sine, Kevin; Forlenza, Christopher J.; Cahlon, Oren; Wolden, Suzanne L.
• Is Part Of: Radiotherapy and oncology. Volume 168(2022)
• Page Start: 46
• Page End: 52
• Publication Date: 2022-03
• Subjects: ABVD Doxorubicin hydrochloride (Adriamycin ®), Bleomycin sulfate, Vinblastine sulfate, Dacarbazine -- ABVE-PC Doxorubicin hydrochloride (Adriamycin ®), Bleomycin sulfate, Vincristine sulfate, Etoposide, Prednisone, Cyclophosphamide -- ASCT Autologous stem cell transplant -- BEACOPP Bleomycin sulfate, Etoposide phosphate, Doxorubicin hydrochloride (Adriamycin ®), Cyclophosphamide, Vincristine sulfate (Oncovin ®), Procarbazine hydrochloride, Prednisone -- CCSS Childhood Cancer Survivor Study -- COG Children's Oncology Group -- CTCAE Common Terminology Criteria for Adverse Events -- Gy Gray -- HL Hodgkin lymphoma -- ILROG International Lymphoma Radiation Oncology Group -- IMRT Intensity-modulated radiation therapy -- ISRT Involved site radiation therapy -- MOPP Mechlorethamine hydrochloride, Vincristine sulfate (Oncovin ®), Procarbazine hydrochloride, Prednisone -- OS Overall survival -- PTV Planned target volume -- PT Proton therapy -- RBE Relative biological effectiveness -- RFS Recurrence free survival -- RT Radiation therapy -- SIR Standardized incidence ratio -- SMR Standardized mortality ratio -- V4Gy Volume receiving 4 Gy (RBE) -- V5Gy Volume receiving 5 Gy (RBE) -- V20Gy Volume receiving 20 Gy (RBE) -- V95% Volume receiving 95% of dose; Hodgkin -- Protons -- Radiation -- Toxicity -- Secondary malignancy; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2022.01.016
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Pediatric Hodgkin lymphoma patients are at risk for treatment-related toxicity. Reduced radiation dose to normal tissues can reduce morbidity and mortality. Use of protons (PT) enabled low heart, lung, and breast dose in 50 pediatric patients. No acute and only 1 subacute potentially PT-related grade 3–5 toxicities occurred. Only 5 patients relapsed (all both in- and out-of-field) and all were salvaged. Abstract: Background and purpose: With high survival rates for pediatric Hodgkin lymphoma (HL), attention has turned to minimizing treatment-related morbidity and mortality. Chemotherapy and dose of radiation to organs at risk (OARs) contribute to elevated risks of secondary malignancy and cardiopulmonary disease. We sought to characterize the radiation dose to OARs, toxicities, and outcomes for pediatric HL patients treated with proton therapy (PT). Materials and methods: Fifty patients aged 11–21 with HL consecutively treated with PT were evaluated 1–2 months following completion of PT and every 6 months thereafter. Acute and late toxicities were captured retrospectively using CTCAE v5. Patterns of relapse were characterized, and survival was assessed using Kaplan-Meier method. Results: Most (47, 94%) patients received PT to the mediastinum. Median mean heart dose was 4.3 Gy (RBE) and median bilateral lung V20Gy was 5.8%. Median integral dose was 1.7 Gy. For the 27 female patients, a median mean dose of 0.4 and 0.3 Gy (RBE) was delivered to ipsilateral and contralateral breast tissue, respectively. No on-treatment grade 3–5 toxicities were seen. At a median follow-up of 5.3 years, no PT-related grade 3–5 toxicities or secondary malignancies developed. Five patients relapsed at a median time of 9.2 months after PT (range 2.5–24.9 months; 5-year recurrence free survival 90%). Recurrences were both in- and out-of-field in all 5 cases with no marginal failures. All relapsed patients were successfully salvaged (5-year overall survival 100%). Conclusion: For pediatric HL patients, proton treatment resulted in marked dose sparing of OARs with low rates of toxicity, no marginal failures, and excellent 5-year survival.