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Irradiating Residual Disease to 30 Gy with Proton Therapy in Pediatric Mediastinal Hodgkin Lymphoma
Bradford S Hoppe1, Raymond B Mailhot Vega2, Nancy P Mendenhall2
1Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.
Insights
Boosting radiation doses for pediatric Hodgkin lymphoma can improve outcomes. Treating residual disease to 30 Gy reduces organ at risk doses, minimizing late effects while improving treatment efficacy.
Area of Science:
- Oncology
- Radiation Oncology
- Pediatric Cancer
Background:
- Local relapse is common in pediatric Hodgkin lymphoma (PHL).
- Current PHL radiotherapy doses (approx. 20 Gy) are lower than effective adult doses (30-36 Gy).
- Investigating dose escalation requires understanding effects on organs at risk (OARs).
Purpose of the Study:
- To evaluate the dosimetric impact of escalating radiotherapy doses to 30 Gy in PHL.
- To compare different dose escalation strategies on target coverage and OAR exposure.
Main Methods:
- Re-planning of proton therapy for 10 PHL patients treated with 21 Gy involved-site radiation therapy (ISRT21Gy).
- Simulated three 30 Gy strategies: ISRT30Gy, residual ISRT boost (rISRTboost), and residual ISRT 30 Gy (rISRT30Gy).
- Compared radiation doses to OARs across all treatment plans.
Main Results:
- ISRT30Gy increased both target and OAR doses.
- rISRTboost increased residual target dose by 42% with only 17-26% OAR dose increase.
- rISRT30Gy increased residual target dose by 42% and decreased OAR dose by 25-46%.
Conclusions:
- Boosting the residual target dose to 30 Gy allows escalation with minimal OAR dose increase.
- Treating residual disease to 30 Gy significantly reduces OAR dose compared to ISRT21Gy.
- Further studies are needed to assess these strategies for improved PHL outcomes and reduced late effects.
Background:
Local relapse is a predominant form of recurrence among pediatric patients with Hodgkin lymphoma (PHL). Although PHL radiotherapy doses have been approximately 20 Gy, adults with Hodgkin lymphoma receiving 30 to 36 Gy experience fewer in-field relapses. We investigated the dosimetric effect of such a dose escalation to the organs at risk (OARs).
Materials And Methods:
Ten patients with PHL treated with proton therapy to 21 Gy involved-site radiation therapy (ISRT21Gy) were replanned to deliver 30 Gy by treating the ISRT to 30 Gy (ISRT30Gy), delivering 21 Gy to the ISRT plus a 9-Gy boost to postchemotherapy residual volume (rISRTboost), and delivering 30 Gy to the residual ISRT target only (rISRT30Gy). Radiation doses to the OARs were compared.
Results:
The ISRT30Gy escalated the dose to the target by 42% but also to the OARs. The rISRTboost escalated the residual target dose by 42%, and the OAR dose by only 17% to 26%. The rISRT30Gy escalated the residual target dose by 42% but reduced the OAR dose by 25% to 46%.
Conclusion:
Boosting the postchemotherapy residual target dose to 30Gy can allow for dose escalation with a slight OAR dose increase. Treating the residual disease for the full 30Gy, however, would reduce the OAR dose significantly compared with ISRT21Gy. Studies should evaluate these strategies to improve outcomes and minimize the late effects.
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