Effective Dose Reduction to Cardiac Structures Using Protons Compared With 3DCRT and IMRT in Mediastinal Hodgkin Lymphoma

Hoppe, Bradford S.; Flampouri, Stella; Su, Zhong; Latif, Naeem; Dang, Nam H.; Lynch, James W.; Joyce, Michael; Sandler, Eric; Li, Zuofeng; Mendenhall, Nancy P.

doi:10.1016/j.ijrobp.2011.12.034

Cited by 122 publications

(80 citation statements)

References 13 publications

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“…Involved field radiotherapy has been reported to give a median MHD of 17.2 Gy for prescribed doses of 35 Gy and involved node radiotherapy leads to even lower doses (median MHDs of 7.7-12.0 Gy for prescribed doses of 36 Gy). [33][34][35] Also, anthracycline doses are nowadays frequently lower than the doses received by the majority of patients in our study. Therefore, patients treated today are likely to be at a substantially lower risk of treatment-related HF than the patients included in this study.…”

Section: Discussionmentioning

confidence: 66%

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

Nimwegen

Ntentas

Darby

et al. 2017

Blood

188

163

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Key Points• Risk of HF increases following cardiac radiation doses above 20 Gy.• Anthracyclines increase HF rate by threefold independently of radiation.Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2617 five-year survivors of HL diagnosed before age 51 years during 1965 to 1995, was conducted. Cases (n 5 91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n 5 278) were matched to cases on age, sex, and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean heart doses and mean left ventricular doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls (P difference 5 .003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLD of 1-15, 16-20, 21-25, and ‡26 Gy were 1.27, 1.65, 3.84, and 4.39, respectively (P trend < .001). Anthracyclinecontaining chemotherapy increased HF rate by a factor of 2.83 (95% CI: 1.43-5.59), and there was no significant interaction with MLVD (P interaction 5 .09). Twenty-five-year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ‡21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up. (Blood. 2017;129(16):2257-2265 Medscape Continuing

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Section: Discussionmentioning

confidence: 66%

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

Nimwegen

Ntentas

Darby

et al. 2017

Blood

188

163

View full text Add to dashboard Cite

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“…Proton therapy enhances the ability to deliver conformal radiation treatments while sparing surrounding normal tissues. For mediastinal lymphoma (ML), passive scattering proton therapy has been shown to deliver a conformal dose to the tumor while decreasing dose to normal tissues like lung, esophagus, heart, and coronary arteries [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

et al. 2016

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Background: Modern radiotherapy (RT) for lymphoma is highly personalized. While advanced imaging is largely employed to define limited treatment volumes, the use of proton pencil beam scanning (PBS) for highly conformal lymphoma RT is still in its infancy. Here, we assess the dosimetric benefits and feasibility of PBS for mediastinal lymphoma (ML). Materials and methods: Ten patients were planned using PBS for involved-site RT. The initial plans were calculated on the average four-dimensional computed tomography (4D-CT). PBS plans were compared with 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and proton double scattering (DS). In order to evaluate the feasibility of PBS and the plan robustness against interand intra-fractional uncertainties, the 4D dose was calculated on initial and verification CTs. The deviation of planned dose from delivered dose was measured. The same proton beamline was used for all patients, while another beamline with larger spots was employed for patients with large motion perpendicular to the beam. Results: PBS provided the lowest mean lung dose (MLD) and mean heart dose (MHD) for all patients in comparison with 3D-CRT, IMRT, and DS. For eight patients, internal target volume (ITV) D 98% was degraded by <3%; and the MLD and MHD deviated by <10% of prescription over the course of treatment when the PBS field was painted twice in each session. For one patient with target motion perpendicular to the beam (>5 mm), the degradation of ITV D 98% was 9%, which was effectively mitigated by employing large spots. One patient exhibited large dose degradation due to pericardial effusion, which required replanning across all modalities. Conclusions: This study demonstrates that PBS plans significantly reduce MLD and MHD relative to 3D-CRT, IMRT, and DS and identifies requirements for robust free-breathing ML PBS treatments, showing that PBS plan robustness can be maintained with repainting and/or large spots.

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“…Biological modeling using follow‐up information from patients receiving radiotherapy offers a method of interpreting the dose‐volume data of treatment plans to predict outcomes 13 , 14 . Dose planning studies have previously suggested that advanced radiotherapy techniques could reduce the dose to the organs at risk (OAR) considered in this work 15 , 16 , 17 . Brodin et al (18) review models for risks of specific radiation‐induced effects in patients with HL, focusing on linear models that rely on mean dose for calculation of risk for cancer induction.…”

Section: Introductionmentioning

confidence: 99%

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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In 2010, all young patients treated for intrathoracic Hodgkin lymphoma (HL) at one of 10 radiotherapy centers in the province of Quebec received 3D conformal photon therapy. These patients may now be at risk for late effects of their treatment, notably secondary malignancies and cardiac toxicity. We hypothesized that more complex radiotherapy, including intensity‐modulated proton therapy (IMPT) and possibly IMRT (in the form of helical tomotherapy (HT)), could benefit these patients. With institutional review board approval at 10 institutions, all treatment plans for patients under the age of 30 treated for HL during a six‐month consecutive period of 2010 were retrieved. Twenty‐six patients were identified, and after excluding patients with extrathoracic radiation or treatment of recurrence, 20 patients were replanned for HT and IMPT. Neutron dose for IMPT plans was estimated from published measurements. The relative seriality model was used to predict excess risk of cardiac mortality. A modified linear quadratic model was used to predict the excess absolute risk for induction of lung cancer and, in female patients, breast cancer. Model parameters were derived from published data. Predicted risk for cardiac mortality was similar among the three treatment techniques (absolute excess risk of cardiac mortality was not reduced for HT or IMPT (p>0.05,p>0.05) as compared to 3D CRT). Predicted risks were increased for HT and reduced for IMPT for secondary lung cancer (p<0.001,p<0.001) and breast cancers (p<0.001,p<0.001) as compared to 3D CRT.PACS numbers: 87.55.dh, 87.55.dk

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Effective Dose Reduction to Cardiac Structures Using Protons Compared With 3DCRT and IMRT in Mediastinal Hodgkin Lymphoma

Cited by 122 publications

References 13 publications

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

Proton pencil beam scanning for mediastinal lymphoma: treatment planning and robustness assessment

Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

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