Hoppe Bradford S, Mailhot-Vega Raymond B, Renfro Lindsay A, Pei Qinglin, Charpentier Anne-Marie, Parikh Rahul R, Roberts Kenneth B, Keller Frank G, Punnett Angela, Parsons Susan, Voss Stephan D, Alzaraki Adina, McCarten Kathleen M, Flampouri Stella, Kessel Sandy, Wu Yue, Cho Stephen Y, Kelly Kara M, Castellino Sharon M, Hodgson David C
Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida; Nemours Children's Health, Jacksonville, Florida.
Department of Radiation Oncology, University of Florida Proton Therapy Institute, Jacksonville, Florida.
Int J Radiat Oncol Biol Phys. 2025 Jun 28. doi: 10.1016/j.ijrobp.2025.06.3876.
AHOD 1331 was a clinical trial investigating brentuximab vedotin in conjunction with chemotherapy and response adapted radiation therapy (RT) in pediatric patients with high-risk classic Hodgkin lymphoma. RT was delivered using 3-dimensional conformal RT (3D-CRT), intensity modulated RT (IMRT), or proton therapy. This analysis evaluated dosimetric and clinical outcomes for patients treated across these different RT modalities.
After 5 cycles of systemic therapy, patients received 21 Gy of RT to sites including bulky mediastinal disease at diagnosis or partial metabolic responses after 2 cycles. A 9 Gy boost was delivered to sites with partial responses at the end of therapy. Clinical and dosimetric outcomes prospectively collected and were compared for 3D-CRT, IMRT, and proton therapy in a post hoc analysis.
Of 587 enrolled patients, 317 (54%) received protocol-directed RT: 29% with 3D-CRT, 41% with IMRT, 26% with proton therapy, and 4% with mixed modalities. Proton therapy use increased from 16% to 26% to 36% among the first, second, and third tertiles of patients irradiated (P = .045). At a median follow-up of 43 months, 3-year progression-free survival rates were equivalent across modalities (P = .77): 86.6% for 3DCRT, 87.6% for IMRT, and 87.9% for proton therapy. No significant differences were observed in acute grade 3 or higher toxicities. Proton therapy delivered significantly lower mean doses to the heart, breast, and lung compared with IMRT or 3D-CRT, whereas IMRT resulted in higher mean doses to the lungs and breasts compared with 3D-CRT.
Selective use of RT combined with chemotherapy, including brentuximab vedotin, led to excellent outcomes for pediatric patients with high-risk Hodgkin lymphoma. Proton therapy utilization increased during the study, showing similar disease control and toxicity outcomes as 3D-CRT and IMRT. Long-term follow-up is essential to evaluate the risks of secondary malignancies and cardiac toxicity across radiation techniques.
AHOD 1331是一项临床试验，研究本妥昔单抗联合化疗及适应性反应放射治疗（RT）用于高危经典型霍奇金淋巴瘤儿科患者的疗效。放射治疗采用三维适形放疗（3D-CRT）、调强放疗（IMRT）或质子治疗。本分析评估了接受这些不同放疗方式治疗的患者的剂量学和临床结果。
在进行5个周期的全身治疗后，患者接受21 Gy的放疗，照射部位包括诊断时的巨大纵隔病变或2个周期后的部分代谢反应部位。在治疗结束时，对部分反应部位给予9 Gy的追加剂量。在一项事后分析中，对3D-CRT、IMRT和质子治疗的临床和剂量学结果进行前瞻性收集并比较。
在587例入组患者中，317例（54%）接受了方案指导的放疗：29%采用3D-CRT，41%采用IMRT，26%采用质子治疗，4%采用混合模式。在接受放疗的患者的第一个、第二个和第三个三分位数中，质子治疗的使用率从16%增加到26%再增加到36%（P = 0.045）。中位随访43个月时，各放疗方式的3年无进展生存率相当（P = 0.77）：3D-CRT为86.6%，IMRT为87.6%，质子治疗为87.9%。在急性3级或更高毒性方面未观察到显著差异。与IMRT或3D-CRT相比，质子治疗对心脏、乳腺和肺的平均剂量显著更低，而与3D-CRT相比，IMRT对肺和乳腺的平均剂量更高。
选择性地使用放疗联合化疗，包括本妥昔单抗，可为高危霍奇金淋巴瘤儿科患者带来良好的治疗效果。在研究过程中，质子治疗的使用率有所增加，显示出与3D-CRT和IMRT相似的疾病控制和毒性结果。长期随访对于评估不同放疗技术导致的二次恶性肿瘤风险和心脏毒性至关重要。
