Dosimetric Comparison of Involved-Field Three-Dimensional Conformal Photon Radiotherapy and Breast-Sparing Proton Therapy for the Treatment of Hodgkin’s Lymphoma in Female Pediatric Patients

Andolino, David L.; Hoene, Ted A.; Xiao, Lü; Buchsbaum, Jeffrey C.; Chang, Andrew L.

doi:10.1016/j.ijrobp.2011.01.061

Cited by 38 publications

(31 citation statements)

References 18 publications

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“…However, some of the comparative dosimetric studies used an AP-PA field approach to treat these patients, which may not have maximized the benefit of protons. For example, Horn et al (56) and Cella et al (57) typically used AP-PA field arrangements for their proton plans whereas Andolino et al (59) used only posterior fields in a focused effort to restrict breast dose but may not have maximized cardiac dose sparing. Consequently, it is hard for this review to describe detailed evaluations of the fields used.…”

Section: Review Of Dosimetric Studies and Specific Oarsmentioning

confidence: 99%

“…Of the 9 published studies evaluating the dosimetric benefits of proton therapy on cardiac dose, 7 demonstrated improvements compared with photon techniques (53,(55)(56)(57)(58)(59)(61)(62)(63) (Table E1; available online at www.redjournal.org). Seven of these studies evaluated passive-scanning proton therapy, and 2 evaluated an active scanning technique.…”

Section: Heartmentioning

confidence: 99%

See 1 more Smart Citation

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

Tseng

Cutter

Plastaras

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Section: Review Of Dosimetric Studies and Specific Oarsmentioning

confidence: 99%

Section: Heartmentioning

confidence: 99%

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

Tseng

Cutter

Plastaras

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…Reducing the incidence of cardiotoxity and secondary cancers in a truly vulnerable population makes proton therapy a logical next step. Indeed, as some move to further exclude the use of radiation therapy in children with Hodgkin lymphoma because the competing risks of secondary cancer and debilitating late effects exceed the incidence of disease recurrence (56), balance can be achieved only through the rational reduction in the targeted volume and advancement of newer methods (57, 58). The Hodgkin lymphoma committee in the COG is set to meet these goals, as it has completed its first trial for high-risk Hodgkin lymphoma that includes 3-dimensional targeting.…”

Section: Hodgkin Lymphomamentioning

confidence: 99%

Clinical Controversies: Proton Therapy for Pediatric Tumors

Merchant¹

2013

Seminars in Radiation Oncology

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Despite the claim in the published literature, the introduction of proton therapy for children is not analogous to the evolution of conformal photon irradiation relying on the understanding of the impact of altered dose distributions. The differences in radiobiological effect when comparing photons to protons means that we are comparing a known entity to an unknown entity: the dose-volume histogram for proton therapy might mean something substantially different than the dose-volume histogram for photon therapy. The multifaceted difference between the two modalities supports the argument for careful evaluation, follow-up and clinical trials with adverse event monitoring when using proton therapy in children. We review the current data on the outcome of proton therapy in a range of pediatric tumours and compare them to the often excellent results of photon therapy in the setting of multidisciplinary management of childhood cancer. It is hoped that the apparent dosimetric advantage of proton therapy over photons will lead to improved indications for therapy, disease control and functional outcomes. While physical dose distribution is of clear importance, the multimodality management of children by an expert pediatric oncology team and the availability of ancillary measures that improve the quality of treatment delivery may be more important than the actual beam. In addition, current estimates of the benefit of proton therapy over photon therapy based on toxicity reduction will only be realized when survivorship has been achieved. Once substantive data proton therapy data become available, it will be necessary to demonstrate benefit in clinically relevant outcome measures in comparison to best existing photon outcome data. Such an effort will require improved funding and appreciation for late effects research. Only real clinical outcome data combined with better understanding of the radiobiological differences between protons and photons will help us to further reduce side effects in children and exploit the full curative potential of this relatively new modality.

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“…One strategy to reduce the incidence and severity of late effects is to reduce the dose to healthy tissues by using advanced-technology treatment techniques, such as photon intensity modulated radiotherapies (IMRT) or proton treatments. Studies have shown proton treatments may reduce dose to healthy tissue in HL studies while maintaining equal dosimetric coverage of the tumor compared to photon treatments [8][9][10][11] . These studies, however, did not include accurate assessments of stray radiation outside the therapeutic field.…”

Section: Introductionmentioning

confidence: 99%

The need for individualized studies to compare radiogenic second cancer (RSC) risk in proton versus photon Hodgkin Lymphoma patient treatments

et al. 2016

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For Hodgkin Lymphoma (HL), proton therapy has been shown to potentially reduce therapeutic dose to healthy tissue and therefore the risk of developing a radiogenic second cancer (RSC) relative to photon therapy. Currently, commercial treatment planning systems (TPS) do not account for stray radiation doses for these treatments and their risks of late effects. Treatment plans were created and therapeutic doses were calculated with commercial TPSs for the breast, lung, and thyroid of nine HL patients. Stray dose contributions were added by thermoluminescent dosimeter (TLD) measurements in an anthropomorphic phantom for the intensity modulated radiation therapy (IMRT) treatments and personalized Monte Carlo simulations for the proton treatments. The mean relative risk ( ) of developing a RSC following HL treatment with proton therapies was then calculated and compared to photon IMRT, and reported with the metric ratio of relative risk (RRR). Results showed generally lower RSC risks after proton therapy than photon IMRT when averaged over all patients in the cohort for the breast ( = 0.84±0.03), lung ( = 0.77±0.03), and thyroid ( = 0.83±0.05), but were not universal across all patients examined. Our findings revealed that it is important to include stray dose contributions when comparing the RSC risks for different HL treatment techniques and demonstrated the importance of personalized dose and risk calculations for modern HL radiotherapy.

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Dosimetric Comparison of Involved-Field Three-Dimensional Conformal Photon Radiotherapy and Breast-Sparing Proton Therapy for the Treatment of Hodgkin’s Lymphoma in Female Pediatric Patients

Cited by 38 publications

References 18 publications

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

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

Clinical Controversies: Proton Therapy for Pediatric Tumors

The need for individualized studies to compare radiogenic second cancer (RSC) risk in proton versus photon Hodgkin Lymphoma patient treatments

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