title: Proton therapy to the subdiaphragmatic region in the management of patients with Hodgkin lymphoma.
abstract: Twelve consecutive patients with classical Hodgkin lymphoma (HL) involving diaphragmatic or subdiaphragmatic regions were treated on an institutional review board-approved outcomes tracking protocol. All patients underwent treatment with proton therapy following chemotherapy and had comparative three-dimensional conformal photon radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) plans to evaluate differences in dose to organs at risk (OARs). Among the cohort, stomach doses with 3DCRT, IMRT and proton therapy were 21 Gy (median), 14 Gy and 6 Gy, respectively. Median dose reductions with proton therapy compared with 3DCRT and IMRT were 13 Gy (p = 0.0022) and 8 Gy (p = 0.0022) for the stomach. Additionally, there was significant dose reduction using proton therapy for the liver, pancreas, bowel, left kidney and right kidney. Proton therapy reduces the dose to the stomach, liver, pancreas, small bowel and kidneys compared with 3DCRT or IMRT in patients with HL requiring abdominal radiotherapy. These dose reductions are expected to translate into lower risks of secondary cancers and other late toxicities in survivors of HL.
authors.affiliation: University of Florida Proton Therapy Institute , Jacksonville, FL , USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Sachsman
authors.forename: Bradford S
authors.initials: BS
authors.lastname: Hoppe
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Mendenhall
authors.forename: Adam
authors.initials: A
authors.lastname: Holtzman
authors.forename: Zuofeng
authors.initials: Z
authors.lastname: Li
authors.forename: William
authors.initials: W
authors.lastname: Slayton
authors.forename: Mike
authors.initials: M
authors.lastname: Joyce
authors.forename: Eric
authors.initials: E
authors.lastname: Sandler
authors.forename: Stella
authors.initials: S
authors.lastname: Flampouri
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003964:Diaphragm / Q000528:radiation effects*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk / Q000528:radiation effects*; D011379:Prognosis; D011446:Prospective Studies; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D055815:Young Adult
keywords: Hodgkin lymphoma; Proton therapy; dosimetry; particle therapy