Reducing Heart Dose with Protons and Cardiac Substructure Sparing for Mediastinal Lymphoma Treatment

Taparra, Kekoa; Lester, Scott C.; Harmsen, William S.; Petersen, M.; Funk, Ryan K.; Blanchard, Miran J.; Young, Phillip M.; Herrmann, Joerg; Hunzeker, Ashley; Schultz, Heather; McCollough, C; Tasson, A; Leng, Shuai; Martenson, James A.; Whitaker, Thomas J.; Williamson, Eric E.; Laack, Nadia N.

doi:10.14338/ijpt-20-00010.1

Cited by 10 publications

(2 citation statements)

References 41 publications

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“…In this respect, current NTCP cardiotoxicity models, which are all developed with photon-based RT techniques, could be misleading when applied to proton therapy. Nevertheless, dosimetric comparison between HL proton therapy and photon techniques (3D or IMRT) demonstrated a significant gain on all cardiac substructures (cardiac cavities, valves, and coronary arteries) [7], and Taparra et al [25] found that the superiority of IMPT over IMRT at the substructure level was conserved even with ECG-gated cardiac substructure sparing (CSS) planning. An example of comparative dosimetry between IMPT and IMRT is provided in Figure 1.…”

Section: Reduction Of Radiation-induced Cardiotoxicitymentioning

confidence: 99%

Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence

Loap

Mirandola

Marzi

et al. 2021

Cancers

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Consolidative radiation therapy (RT) is of prime importance for early-stage Hodgkin lymphoma (HL) management since it significantly increases progression-free survival (PFS). Nevertheless, first-generation techniques, relying on large irradiation fields, delivered significant radiation doses to critical organs-at-risk (OARs, such as the heart, to the lung or the breasts) when treating mediastinal HL; consequently, secondary cancers, and cardiac and lung toxicity were substantially increased. Fortunately, HL RT has drastically evolved and, nowadays, state-of-the-art RT techniques efficiently spare critical organs-at-risks without altering local control or overall survival. Recently, proton therapy has been evaluated for mediastinal HL treatment, due to its possibility to significantly reduce integral dose to OARs, which is expected to limit second neoplasm risk and reduce late toxicity. Nevertheless, clinical experience for this recent technique is still limited worldwide. Based on current literature, this critical review aims to examine the current practice of proton therapy for mediastinal HL irradiation.

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Section: Reduction Of Radiation-induced Cardiotoxicitymentioning

confidence: 99%

Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence

Loap

Mirandola

Marzi

et al. 2021

Cancers

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“…16 Advanced radiation techniques permit significantly increased precision in treatment planning, allowing preferential sparing of various portions of the heart. 17 Understanding the response of specific cardiac substructures to radiation dose may allow prioritization of substructure sparing in treatment planning to reduce long-term burden of disease. Recent reviews of multiple adult malignancies have called for investigation into the relationship between radiation doses to cardiac substructures and late cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Substructure Radiation Dose and Risk of Late Cardiac Disease in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Bates

Shrestha

Liu

et al. 2023

JCO

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PURPOSE Radiation-associated cardiac disease is a major cause of morbidity/mortality among childhood cancer survivors. Radiation dose-response relationships for cardiac substructures and cardiac diseases remain unestablished. METHODS Using the 25,481 5-year survivors of childhood cancer treated from 1970 to 1999 in the Childhood Cancer Survivor Study, we evaluated coronary artery disease (CAD), heart failure (HF), valvular disease (VD), and arrhythmia. We reconstructed radiation doses for each survivor to the coronary arteries, chambers, valves, and whole heart. Excess relative rate (ERR) models and piecewise exponential models evaluated dose-response relationships. RESULTS The cumulative incidence 35 years from diagnosis was 3.9% (95% CI, 3.4 to 4.3) for CAD, 3.8% (95% CI, 3.4 to 4.2) for HF, 1.2% (95% CI, 1.0 to 1.5) for VD, and 1.4% (95% CI, 1.1 to 1.6) for arrhythmia. A total of 12,288 survivors (48.2%) were exposed to radiotherapy. Quadratic ERR models improved fit compared with linear ERR models for the dose-response relationship between mean whole heart and CAD, HF, and arrhythmia, suggesting a potential threshold dose; however, such departure from linearity was not observed for most cardiac substructure end point dose-response relationships. Mean doses of 5-9.9 Gy to the whole heart did not increase the risk of any cardiac diseases. Mean doses of 5-9.9 Gy to the right coronary artery (rate ratio [RR], 2.6; 95% CI, 1.6 to 4.1) and left ventricle (RR, 2.2; 95% CI, 1.3 to 3.7) increased risk of CAD, and to the tricuspid valve (RR, 5.5; 95% CI, 2.0 to 15.1) and right ventricle (RR, 8.4; 95% CI, 3.7 to 19.0) increased risk of VD. CONCLUSION Among children with cancer, there may be no threshold dose below which radiation to the cardiac substructures does not increase the risk of cardiac diseases. This emphasizes their importance in modern treatment planning.

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Proton Radiation Therapy After Chemotherapy in the Management of Aggressive Mediastinal Non-Hodgkin Lymphomas: A Particle Therapy Cooperative Group Lymphoma Subcommittee Collaboration

Baron¹,

Wright²,

Maxwell³

et al. 2023

Advances in Radiation Oncology

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Reducing Heart Dose with Protons and Cardiac Substructure Sparing for Mediastinal Lymphoma Treatment

Cited by 10 publications

References 41 publications

Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence

Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence

Cardiac Substructure Radiation Dose and Risk of Late Cardiac Disease in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Proton Radiation Therapy After Chemotherapy in the Management of Aggressive Mediastinal Non-Hodgkin Lymphomas: A Particle Therapy Cooperative Group Lymphoma Subcommittee Collaboration

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