Consolidative proton therapy after chemotherapy for patients with Hodgkin lymphoma

• Published in: Annals of oncology Vol. 28; no. 9; pp. 2179 - 2184
• Main Authors: Hoppe, B.S., Hill-Kayser, C.E., Tseng, Y.D., Flampouri, S., Elmongy, H.M., Cahlon, O., Mendenhall, N.P., Maity, A., McGee, L.A., Plastaras, J.P.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2017; Oxford University Press
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemoradiotherapy - adverse effects; chemotherapy; Child; Female; Hodgkin Disease - diagnostic imaging; Hodgkin Disease - drug therapy; Hodgkin Disease - radiotherapy; Hodgkin lymphoma; Humans; Male; Middle Aged; Multimodal Imaging; Original; Positron-Emission Tomography; Proton Therapy; radiotherapy; Tomography, X-Ray Computed; Young Adult; radiotherapy; proton therapy; chemotherapy; Hodgkin lymphoma
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdx287

We investigated early outcomes for patients receiving chemotherapy followed by consolidative proton therapy (PT) for the treatment of Hodgkin lymphoma (HL).
From June 2008 through August 2015, 138 patients with HL enrolled on either IRB-approved outcomes tracking protocols or registry studies received consolidative PT. Patients were excluded due to relapsed or refractory disease. Involved-site radiotherapy field designs were used for all patients. Pediatric patients received a median dose of 21 Gy(RBE) [range 15–36 Gy(RBE)]; adult patients received a median dose of 30.6 Gy(RBE) [range, 20–45 Gy(RBE)]. Patients receiving PT were young (median age, 20 years; range 6–57). Overall, 42% were pediatric (≤18 years) and 93% were under the age of 40 years. Thirty-eight percent of patients were male and 62% female. Stage distribution included 73% with I/II and 27% with III/IV disease. Patients predominantly had mediastinal involvement (96%) and bulky disease (57%), whereas 37% had B symptoms. The median follow-up was 32 months (range, 5–92 months).
The 3-year relapse-free survival rate was 92% for all patients; it was 96% for adults and 87% for pediatric patients (P = 0.18). When evaluated by positron emission tomography/computed tomography scan response at the end of chemotherapy, patients with a partial response had worse 3-year progression-free survival compared with other patients (78% versus 94%; P = 0.0034). No grade 3 radiation-related toxicities have occurred to date.
Consolidative PT following standard chemotherapy in HL is primarily used in young patients with mediastinal and bulky disease. Early relapse-free survival rates are similar to those reported with photon radiation treatment, and no early grade 3 toxicities have been observed. Continued follow-up to assess late effects is critical.