Consolidative active scanning proton therapy for mediastinal lymphoma: selection criteria, treatment implementation and clinical feasibility

Dionisi, Francesco; Scartoni, D.; Rombi, Barbara; Vennarini, Sabina; Righetto, Roberto; Farace, Paolo; Lorentini, Stefano; Schwarz, Marco; Murro, Luana Di; Demofonti, C; D’Angelillo, Rolando Maria; Petrongari, M G; Sanguineti, Giuseppe; Amichetti, Maurizio

doi:10.1007/s00066-022-01918-1

Cited by 2 publications

(10 citation statements)

References 32 publications

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“…Studies including mediastinal lymphoma patients treated with PBS-PT in DIBH or free breathing (FB) are still limited [8,11,15,[24][25][26][27]. Furthermore, most previous studies have focused on dosimetric comparisons between proton and photon RT or radiation toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…To address this, the current focus of mediastinal lymphoma treatments has been to achieve high disease control while simultaneously reducing the side effects by decreasing the irradiated volume and the prescribed dose [4][5][6]. Utilizing protons, with their well-defined range and sharp dosedrop at the end of their tracks, a high dose conformity to the target can be obtained as well as further organs at risk (OARs) sparing compared to photon therapy [7,8]. Because of these properties, proton therapy (PT) is expected to have a positive impact in the treatment of mediastinal lymphomas compared to photon RT [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness

Hörberger,

Andersson,

Enmark

et al. 2024

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Purpose/background: The aim of this study was to evaluate pencil beam scanning (PBS) proton therapy (PT) in deep inspiration breath-hold (DIBH) for mediastinal lymphoma patients, by retrospectively evaluating plan robustness to the clinical target volume (CTV) and organs at risk (OARs) on repeated CT images acquired throughout treatment. Methods: Sixteen mediastinal lymphoma patients treated with PBS-PT in DIBH were included. Treatment plans (TPs) were robustly optimized on the CTV (7 mm/4.5%). Repeated verification CTs (vCT) were acquired during the treatment course, resulting in 52 images for the entire patient cohort. The CTV and OARs were transferred from the planning CT to the vCTs with deformable image registration and the TPs were recalculated on the vCTs. Target coverage and OAR doses at the vCTs were compared to the nominal plan. Deviation in lung volume was also calculated. Results: The TPs demonstrated high robust target coverage throughout treatment with D98%,CTV deviations within 2% for 14 patients and above the desired requirement of 95% for 49/52 vCTs. However, two patients did not achieve a robust dose to CTV due to poor DIBH reproducibility, with D98%,CTV at 78 and 93% respectively, and replanning was performed for one patient. Adequate OAR sparing was achieved for all patients. Total lung volume variation was below 10% for 39/52 vCTs. Conclusion: PBS PT in DIBH is generally a robust technique for treatment of mediastinal lymphomas. However, closely monitoring the DIBH-reproducibility during treatment is important to avoid underdosing CTV and achieve sufficient dose-sparing of the OARs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness

Hörberger,

Andersson,

Enmark

et al. 2024

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“…In total, 11 studies met the inclusion criteria (Fig. 1) [24][25][26][27][28][29][30][31][32][33][34]. The characteristics of the included publications are shown in Appendix 1.…”

Section: Description Of the State Of Knowledgementioning

confidence: 99%

“…The age range of the patients at the time of diagnosis was 5 -73 years [27,33]. The follow-up time varied with a median range of 15 -63.6 months [25,32]. Most patients were female (range: 50% -75%) [34,26] The most common indication was Hodgkin lymphoma (described in all studies), whereas patients with non-Hodgkin lymphoma were described in 5 studies [25,28,29,31,33].…”

Section: Description Of the State Of Knowledgementioning

confidence: 99%

“…The follow-up time varied with a median range of 15 -63.6 months [25,32]. Most patients were female (range: 50% -75%) [34,26] The most common indication was Hodgkin lymphoma (described in all studies), whereas patients with non-Hodgkin lymphoma were described in 5 studies [25,28,29,31,33]. Most patients had stage 2 according to Lugano/ Ann Arbor staging system.…”

Section: Description Of the State Of Knowledgementioning

confidence: 99%

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Evidence for external beam radiotherapy in mediastinal Hodgkin and non-Hodgkin lymphoma – systematic review

Kowalska,

Sitarz-Kilian,

Jaros

et al. 2023

Ann Agric Environ Med.

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Introduction and objective. Proton beam therapy (PBT) provides the opportunity for a more localized delivery of high energy protons and may reduce the damage to healthy tissues and vital organs. The aim of this review was to assess the effects of proton therapy for patients diagnosed with Hodgkin or non-Hodgkin lymphoma treated with mediastinal irradiation. Review methods. A systematic search of EMBASE, MEDLINE via OVID and Cochrane Library was conducted in May 2022 according to PRISMA guidelines to identify relevant data on the efficacy and toxicity of proton beam therapy for patients diagnosed with Hodgkin or non-Hodgkin lymphoma. Brief description of the state of knowledge. Of 566 screened abstracts (430 after de-duplication) 11 studies with a total of 529 patients were included. All studies were case series published between 2011-2021. Median range of follow-up time was 15-63.6 months. The overall survival (OS) for 2 years varied from 91% -98% for 5 of the included studies. Three of the included studies had favourable outcomes with 2-year progression-free survival (PFS) ranging from 73% -94%. Skin reaction, oesophagitis and fatigue were found to be the most common grade 1 and grade 2 toxicities. No acute or late grade 4 and higher toxicities/adverse events were observed. Summary. There are data indicating that PBT may to be an effective treatment against mediastinal Hodgkin and non-Hodgkin lymphoma. Because all the studies were case series, the authors of this review have little confidence in the evidence. There remains a need for well-designed randomized controlled trials to inform about the optimal approach to proton irradiation in HL and NHL.

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Consolidative active scanning proton therapy for mediastinal lymphoma: selection criteria, treatment implementation and clinical feasibility

Cited by 2 publications

References 32 publications

Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness

Pencil beam scanning proton therapy for mediastinal lymphomas in deep inspiration breath-hold: a retrospective assessment of plan robustness

Evidence for external beam radiotherapy in mediastinal Hodgkin and non-Hodgkin lymphoma – systematic review

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