title: The impact of protocol assignment for older adolescents with hodgkin lymphoma.
abstract: OBJECTIVE
  Hodgkin lymphoma (HL) treatment has evolved to reduce or avoid radiotherapy (RT) dose and volume and minimize the potential for late effects. Some older adolescents are treated on adult protocols. The purpose of this study is to examine the protocol assignment of older adolescents and its impact on radiation dose to relevant thoracic structures.
  
  
  METHODS
  Cooperative group data were reviewed and 12 adolescents were randomly selected from a pediatric HL protocol. Treatment plans were generated per one pediatric and two adult protocols. Dose volume histograms for heart, lung, and breast allowed comparison of radiation dose to these sites across these three protocols.
  
  
  RESULTS
  A total of 15.2% of adolescents were treated on adult HL protocols and received significantly higher radiation dosage to heart and lung compared to pediatric HL protocols. Adolescents treated on either pediatric or adult protocols received similar RT dose to breast.
  
  
  CONCLUSIONS
  Older adolescents treated on adult HL protocols received higher RT dose to thoracic structures except breast. Level of nodal involvement may impact overall RT dose to breast. The impact of varying field design and RT dose on survival, local, and late effects needs further study for this vulnerable age group. Adolescents, young adults, Hodgkin lymphoma, RT, clinical trials.
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical School, University of Massachusetts Memorial Health Care System , Worcester, MA , USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Pieters
authors.affiliation: Division of Radiation Oncology, Milton S. Hershey Medical Center, Pennsylvania State University , Hershey, PA , USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Wagner
authors.affiliation: Department of Quantitative Health Sciences and Cell Biology, University of Massachusetts Medical School , Worcester, MA , USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
authors.affiliation: Department of Radiation Oncology, Quality Assurance Review Center, University of Massachusetts Medical School , Lincoln, RI , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Morano
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical School, University of Massachusetts Memorial Health Care System , Worcester, MA , USA ; Department of Radiation Oncology, Quality Assurance Review Center, University of Massachusetts Medical School , Lincoln, RI , USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ulin
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical School, University of Massachusetts Memorial Health Care System , Worcester, MA , USA ; Department of Radiation Oncology, Quality Assurance Review Center, University of Massachusetts Medical School , Lincoln, RI , USA.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Cicchetti
authors.affiliation: Department of Radiation Oncology, Quality Assurance Review Center, University of Massachusetts Medical School , Lincoln, RI , USA.
authors.forename: Maryann
authors.initials: M
authors.lastname: Bishop-Jodoin
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical School, University of Massachusetts Memorial Health Care System , Worcester, MA , USA ; Department of Radiation Oncology, Quality Assurance Review Center, University of Massachusetts Medical School , Lincoln, RI , USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: FitzGerald
keywords: Hodgkin lymphoma; adolescents; clinical trials; radiotherapy; young adults