Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

Tseng, Yolanda D.; Cutter, David J.; Plastaras, John P.; Parikh, Rahul R.; Cahlon, Oren; Chuong, Michael D.; Dědečková, K.; Khan, Mohammad K.; Lin, Shang-Hung; McGee, L.A.; Shen, Yeh-You; Terezakis, Stephanie A.; Badiyan, Shahed N.; Kirova, Youlia; Hoppe, Richard T.; Mendenhall, Nancy P.; Pankuch, Mark; Flampouri, Stella; Ricardi, Umberto; Hoppe, B.S.

doi:10.1016/j.ijrobp.2017.05.004

Cited by 68 publications

(52 citation statements)

References 86 publications

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“…Regarding the use of PT, most previous studies for mediastinal HL have investigated the impact on normal tissue dose using the passive scattering technique in FB. In accordance to this study, they showed that the dose to the lungs, heart and breasts was generally reduced for proton compared to photon therapy [6,[17][18][19]. However, in this study, the more advanced delivery technique PBS, which enables even larger normal tissue sparing, has been used.…”

Section: Discussionsupporting

confidence: 61%

“…However, IMPT was more beneficial than VMAT, since it reduced the OAR doses for all dose levels, while VMAT reduced the volumes receiving high doses, however, at the expense of increasing the low-dose volumes. Also, the ID, reflecting the total body radiation exposure, was greatly reduced for all patients using IMPT compared to VMAT and 3D-CRT, potentially leading to a lower risk of secondary malignancies [6]. The lowest doses to the OARs were generally observed for the combination of DIBH and IMPT.…”

Section: Discussionmentioning

confidence: 95%

“…Due to the relatively high survival rate and young age for most HL patients, a large proportion of the patients become longtime survivors and hence late effects of the treatment are of great concern. Previously, extended field radiotherapy (EFRT) and involved field radiotherapy (IFRT) were used to treat entire nodal stations, which has been shown to result in increased mortality from late effects, most commonly from secondary cancer, cardiovascular diseases and respiratory diseases [3][4][5][6]. Modern HL treatment has focused on reducing the risk of late effects while still maintaining high disease control [7].…”

Section: Introductionmentioning

confidence: 99%

“…Deep inspiration breath hold (DIBH) has demonstrated the ability to reduce dose to healthy tissue for mediastinal HL, due to favorable anatomical changes in tumor position in relation to healthy tissue [12][13][14][15][16]. Also, proton therapy (PT) has shown a positive impact on the normal tissue dose compared to photon therapy [6,[17][18][19]. Most studies for mediastinal HL have used the passive scattering technique, however, more modern PT, using pencil beam scanning (PBS) and intensity modulated PT (IMPT), enables even more conformal treatment plans.…”

Section: Introductionmentioning

confidence: 99%

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Comparative treatment planning study for mediastinal Hodgkin’s lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy

Edvardsson

Kügele²,

Alkner

et al. 2018

Acta Oncologica

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Background: Late effects induced by radiotherapy (RT) are of great concern for mediastinal Hodgkin's lymphoma (HL) patients and it is therefore important to reduce normal tissue dose. The aim of this study was to investigate the impact on the normal tissue dose and target coverage, using various combinations of intensity modulated proton therapy (IMPT), volumetric modulated arc therapy (VMAT) and 3-dimensional conformal RT (3D-CRT), planned in both deep inspiration breath hold (DIBH) and free breathing (FB). Material and methods: Eighteen patients were enrolled in this study and planned with involved site RT. Two computed tomography images were acquired for each patient, one during DIBH and one during FB. Six treatment plans were created for each patient; 3D-CRT in FB, 3D-CRT in DIBH, VMAT in FB, VMAT in DIBH, IMPT in FB and IMPT in DIBH. Dosimetric impact on the heart, left anterior descending (LAD) coronary artery, lungs, female breasts, target coverage, and also conformity index and integral dose (ID), was compared between the different treatment techniques. Results: The use of DIBH significantly reduced the lung dose for all three treatment techniques, however, no significant difference in the dose to the female breasts was observed. Regarding the heart and LAD doses, large individual variations were observed. For VMAT, the mean heart and LAD doses were significantly reduced using DIBH, but no significant difference was observed for 3D-CRT and IMPT. Both IMPT and VMAT resulted in improved target coverage and more conform dose distributions compared to 3D-CRT. IMPT generally showed the lowest organs at risk (OAR) doses and significantly reduced the ID compared to both 3D-CRT and VMAT. Conclusions: The majority of patients benefited from treatment in DIBH, however, the impact on the normal tissue dose was highly individual and therefore comparative treatment planning is encouraged. The lowest OAR doses were generally observed for IMPT in combination with DIBH.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative treatment planning study for mediastinal Hodgkin’s lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy

Edvardsson

Kügele²,

Alkner

et al. 2018

Acta Oncologica

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“…Proton therapy for mediastinal tumours has the potential to reduce lung and heart doses compared to photon-based radiotherapy [3]. The combination of pencil beam scanning (PBS) proton therapy and deep inspiration breath-hold (DIBH) technique improves the sparing effect even further [4,5] due to favourable anatomical changes compared to free breathing (FB).…”

Section: Introductionmentioning

confidence: 99%

Pencil beam scanning proton therapy of Hodgkin’s lymphoma in deep inspiration breath-hold: A case series report

Andersson

Edvardsson

Hall³

et al. 2020

Technical Innovations & Patient Support in Radiation Oncolo

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a b s t r a c tBackground: Most patients with Hodgkin's lymphoma are young and have a favourable prognosis, therefore it is of high importance to decrease the radiation doses to normal tissues received during radiotherapy. A combination of proton therapy and deep inspiration breath-hold technique (DIBH) can improve the sparing effect and thereby reduce the risk of late effects. Case presentation: The two first patient cases treated with proton therapy in DIBH at the Skandion Clinic, Uppsala, Sweden, are presented here. Proton treatment plans were compared to photon plans based on doses to target and organs at risk. Several CT scans were acquired during the treatment course and inter breath-hold variations were evaluated based on anatomical distances and dosimetric comparisons. Conclusions: The results from our first patients treated with proton therapy in DIBH imply that the treatment strategy is robust and has the potential to reduce dose to normal tissue.

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Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma

et al. 2019

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IMPORTANCE To date, there is no well-defined standard of care for early-stage pediatric Hodgkin lymphoma (HL), which may include chemotherapy alone or combined modality therapy (CMT) with chemotherapy followed by radiotherapy. Although the use of radiotherapy in pediatric HL is decreasing, this strategy remains controversial. OBJECTIVE To examine the use of CMT in pediatric HL and its association with improved overall survival using data from a large cancer registry. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study used data from the National Cancer Database to evaluate clinical features and survival outcomes among 5657 pediatric patients (age, 0.1-21 years) who

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Evidence-based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee

Cited by 68 publications

References 86 publications

Comparative treatment planning study for mediastinal Hodgkin’s lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy

Comparative treatment planning study for mediastinal Hodgkin’s lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy

Pencil beam scanning proton therapy of Hodgkin’s lymphoma in deep inspiration breath-hold: A case series report

Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma

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