Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Pediatr Blood Cancer. 2024 Dec;71(12):e31290. doi: 10.1002/pbc.31290. Epub 2024 Sep 12.
Proton therapy (PT) has potential advantages in pediatric Hodgkin lymphoma (pHL). However, there are limited data on PT, specifically to infradiaphragmatic targets. We report on PT planning details, doses achieved to organs at risk (OARs), and clinical and toxicity outcomes for patients with pHL who received PT to infradiaphragmatic regions.
This is a retrospective study including patients treated between 2011 and 2022. Demographic and clinical factors were collected, and toxicity was reported using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Dosimetric and clinical factors associated with key outcomes were assessed via Cox regression. Photon plans were generated for all patients, and the paired t-tests or Wilcoxon signed rank sum tests were used for dosimetric comparisons.
Twenty-one patients comprising 22 PT courses were included. Median follow-up was 5.0 years, and mean age was 14.2 years. Median dose was 21 Gray equivalent (GyE) over 14 fractions. Top acute grade 1 (G1) toxicities included fatigue (59%) and anorexia (36%). Rates of acute G2 and G3+ toxicity were 18% and 0%, respectively. After PT, no local or marginal failures occurred. Five percent experienced disease progression, who were all successfully salvaged, and all patients were alive and disease-free at last follow-up. No secondary malignancies developed. Compared to photon radiotherapy, PT achieved significantly lower doses to the bowels, stomach, spleen, pancreatic tail, liver, kidneys, and pelvic bones.
PT is well-tolerated and leads to excellent oncologic and toxicity outcomes with long-term follow-up. PT confers dosimetric advantages when compared to photons.
质子治疗（PT）在儿科霍奇金淋巴瘤（pHL）中有潜在优势。然而，关于 PT 的数据有限，特别是针对膈下目标。我们报告了接受 PT 治疗膈下区域的 pHL 患者的 PT 计划细节、达到的危及器官（OAR）剂量以及临床和毒性结果。
这是一项回顾性研究，包括 2011 年至 2022 年期间接受治疗的患者。收集了人口统计学和临床因素，并使用 CTCAE 版本 5.0 报告毒性。通过 Cox 回归评估与关键结果相关的剂量学和临床因素。为所有患者生成了光子计划，并使用配对 t 检验或 Wilcoxon 符号秩和检验进行剂量学比较。
21 例患者（22 例 PT 疗程）包括在内。中位随访时间为 5.0 年，平均年龄为 14.2 岁。中位剂量为 21 格雷等效剂量（GyE），共 14 个分次。主要急性 1 级（G1）毒性包括疲劳（59%）和厌食（36%）。急性 G2 和 G3+毒性的发生率分别为 18%和 0%。PT 后无局部或边缘失败。5%的患者发生疾病进展，但均成功挽救，所有患者在最后一次随访时均存活且无疾病。无继发恶性肿瘤发生。与光子放疗相比，PT 使肠道、胃、脾脏、胰腺尾部、肝脏、肾脏和骨盆骨的剂量显著降低。
PT 具有良好的耐受性，并在长期随访中带来出色的肿瘤学和毒性结果。与光子相比，PT 具有剂量学优势。
