Proton Therapy in Supradiaphragmatic Lymphoma: Predicting Treatment-Related Mortality to Help Optimize Patient Selection

Ntentas, Georgios; Dědečková, K.; Andrlík, Michal; Aznar, Marianne C.; Shakir, Rebecca; Ramroth, Johanna; Begum, Rowshan Ara; Kubeš, Jiří; Darby, Sarah C.

doi:10.1016/j.ijrobp.2021.10.151

Cited by 6 publications

(10 citation statements)

References 38 publications

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“…Another recent study showed that when CTV overlapped longitudinally with the heart by ≥ 40%, PBT reduced mean heart dose by 3.2 Gy (19% relative decrease), left ventricular dose by 5.6 Gy (50% relative decrease) and valvular doses by 5.1 Gy (24% relative decrease). These measures resulted in a reduction in total CVD AMR 30 in the study among patients in Western Europe by 0.3% from 3.8% to 3.5% [11]. For patients with axillary involvement, PBT reduced mean lung dose by 2.8 Gy (29% relative decrease) and lung cancer AMR 30 among patients in Western Europe by 0.5% from 2.7 to 2.2% [11].…”

Section: Discussionmentioning

confidence: 84%

“…These measures resulted in a reduction in total CVD AMR 30 in the study among patients in Western Europe by 0.3% from 3.8% to 3.5% [11]. For patients with axillary involvement, PBT reduced mean lung dose by 2.8 Gy (29% relative decrease) and lung cancer AMR 30 among patients in Western Europe by 0.5% from 2.7 to 2.2% [11]. Based on the above findings, we calculated the percentage of patients in our cohort falling within these subgroups (Table S2).…”

Section: Discussionmentioning

confidence: 94%

“…Based on the above findings, we calculated the percentage of patients in our cohort falling within these subgroups (Table S2). Forty-one percent (18/44) of patients had a CTV which overlapped longitudinally with the heart by ≥ 40% [11], 70% (31/44) had mediastinal disease which extended below the origin of the LMCA [32] and 52% (23/44) patients had disease which extended below the 7th thoracic vertebra [33]. These patients could have potentially had reduced risk of radiation-related AMR 30 from CVD if treated with PBT.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment-related AMR 30 for CVD and second primary cancers were predicted for all patients in this study. The risk prediction methods are described in detail in two previous studies [11,19]. In brief, for each patient, the background cumulative AMR 30 , in the absence of any lymphoma-related or treatment-related risks, was estimated for each disease of interest using mortality rates in the general Irish population and by taking into account the competing risk of death from other causes.…”

Section: Late Effects Risk Predictionmentioning

confidence: 99%

“…Volumetric modulated arc therapy (VMAT) planning techniques used in combination with DIBH are associated with reduced heart, lung and breast doses [8][9][10]. Proton beam therapy (PBT) may provide additional dosimetric advantages in the treatment of patients with mediastinal lymphoma and may reduce the risk of late effects [11].…”

Section: Introductionmentioning

confidence: 99%

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Predicted cardiac and second cancer risks for patients undergoing VMAT for mediastinal Hodgkin lymphoma

et al. 2022

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Background and purpose To predict treatment-related cardiovascular disease (CVD) and second cancer 30-year absolute mortality risks (AMR30) for patients with mediastinal Hodgkin lymphoma in a large multicentre radiation oncology network in Ireland. Material and methods This study includes consecutive patients treated for mediastinal lymphoma using chemotherapy and involved site radiotherapy (RT) 2016–2019. Radiation doses to heart, left ventricle, cardiac valves, lungs, oesophagus, carotid arteries and female breasts were calculated. Individual CVD and second cancer AMR30 were predicted using Irish background population rates and dose–response relationships. Results Forty-four patients with Hodgkin lymphoma were identified, 23 females, median age 28 years. Ninety-eight percent received anthracycline, 80% received 4–6 cycles ABVD. Volumetric modulated arc therapy (VMAT) ± deep inspiration breath hold (DIBH) was delivered, median total prescribed dose 30 Gy. Average mean heart dose 9.8 Gy (range 0.2–23.8 Gy). Excess treatment-related mean AMR30 from CVD was 2.18% (0.79, 0.90, 0.01, 0.13 and 0.35% for coronary disease, heart failure, valvular disease, stroke and other cardiac diseases), 1.07% due to chemotherapy and a further 1.11% from RT. Excess mean AMR30 for second cancers following RT were: lung cancer 2.20%, breast cancer in females 0.34%, and oesophageal cancer 0.28%. Conclusion For patients with mediastinal lymphoma excess mortality risks from CVD and second cancers remain clinically significant despite contemporary chemotherapy and photon-RT. Efforts to reduce the toxicity of combined modality treatment, for example, using DIBH, reduced margins and advanced RT, e.g. proton beam therapy, should be continued to further reduce potentially fatal treatment effects.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Late Effects Risk Predictionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicted cardiac and second cancer risks for patients undergoing VMAT for mediastinal Hodgkin lymphoma

et al. 2022

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Reappraisal of the role of radiation therapy in lymphoma treatment

Specht

2023

Hematological Oncology

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Radiation therapy (RT) for lymphomas has improved dramatically with modern imaging and treatment techniques, encompassing only the necessary volume with minimal doses to normal structures. Prescribed radiation doses are reduced, and fractionation schedules are under revision. With effective systemic treatment only initial macroscopic disease is irradiated. With no or less effective systemic treatment, possible microscopic disease is also included. Risks of long‐term side effects of RT have diminished dramatically and should be weighed against risks from more systemic treatment or increased risk of relapse. Lymphoma patients are often elderly, they tolerate modern limited RT very well. Lymphomas refractory to systemic treatments often remain radioresponsive, and brief, mild RT may offer effective palliation. New roles for RT are emerging with immune therapies. RT for “bridging,” keeping the lymphoma under control while waiting for immune therapy, is well established. Enhancement of the immune response to lymphomas, so‐called “priming,” is being intensively researched.

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Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma

et al. 2023

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Proton Therapy in Supradiaphragmatic Lymphoma: Predicting Treatment-Related Mortality to Help Optimize Patient Selection

Cited by 6 publications

References 38 publications

Predicted cardiac and second cancer risks for patients undergoing VMAT for mediastinal Hodgkin lymphoma

Predicted cardiac and second cancer risks for patients undergoing VMAT for mediastinal Hodgkin lymphoma

Reappraisal of the role of radiation therapy in lymphoma treatment

Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma

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