scholarly journals Feasibility of Deep Inspiratory Breath Hold in Pediatric Patients Receiving Proton Therapy for Hodgkin Lymphoma Patients to Decrease Radiation Dose to Organs at Risk

2020 ◽  
Vol 108 (3) ◽  
pp. e242
Author(s):  
A.S. Grewal ◽  
E.R. Cummings ◽  
R. Battaglini ◽  
D. Geary ◽  
M. Eishenhower ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Dose ◽  
Hodgkin Lymphoma ◽  
Proton Therapy ◽  
Pediatric Patients ◽  
Organs At Risk ◽  
Breath Hold

scholarly journals Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3744
Author(s):  
Pierre Loap ◽  
Ludovic De Marzi ◽  
Alfredo Mirandola ◽  
Remi Dendale ◽  
Alberto Iannalfi ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Proton Therapy ◽  
Early Stage ◽  
Organs At Risk ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Treatment Techniques ◽  
Increased Risk

Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with technological advances in treatment techniques currently allows efficient organs-at-risk sparing without altering tumoral control. Recently, proton therapy has been evaluated for mediastinal HL treatment due to its potential to significantly reduce the dose to organs-at-risk, such as cardiac substructures. This is expected to limit late radiation-induced toxicity and possibly, second-neoplasm risk, compared with last-generation intensity-modulated radiation therapy. However, the democratization of this new technique faces multiple issues. Determination of which patient may benefit the most from proton therapy is subject to intense debate. The development of new effective systemic chemotherapy and organizational, societal, and political considerations might represent impediments to the larger-scale implementation of HL proton therapy. Based on the current literature, this critical review aims to discuss current challenges and controversies that may impede the larger-scale implementation of mediastinal HL proton therapy.

scholarly journals Irradiating Residual Disease to 30 Gy with Proton Therapy in Pediatric Mediastinal Hodgkin Lymphoma

2020 ◽  
Vol 6 (4) ◽  
pp. 11-16
Author(s):  
Bradford S. Hoppe ◽  
Raymond B. Mailhot Vega ◽  
Nancy P. Mendenhall ◽  
Eric S. Sandler ◽  
William B. Slayton ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Proton Therapy ◽  
Dose Escalation ◽  
Pediatric Patients ◽  
Residual Disease ◽  
Organs At Risk ◽  
Local Relapse ◽  
Radiation Doses ◽  
Target Dose ◽  
Predominant Form

Abstract 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.

scholarly journals Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines

Blood ◽  
2018 ◽  
Vol 132 (16) ◽  
pp. 1635-1646 ◽  
Author(s):  
Bouthaina Shbib Dabaja ◽  
Bradford S. Hoppe ◽  
John P. Plastaras ◽  
Wayne Newhauser ◽  
Katerina Rosolova ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Dose ◽  
Proton Therapy ◽  
Radiation Treatment ◽  
Organs At Risk ◽  
Cardiac Morbidity ◽  
Advantages And Disadvantages ◽  
Treatment Techniques ◽  
Choice Of Treatment ◽  
Patients At Risk

Abstract Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.

scholarly journals Effects of deep inspiration breath hold on prone photon or proton irradiation of breast and regional lymph nodes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bruno Speleers ◽  
Max Schoepen ◽  
Francesca Belosi ◽  
Vincent Vakaet ◽  
Wilfried De Neve ◽  
...  
Keyword(s):  
Lung Cancer ◽  
At Risk ◽  
Lymph Node ◽  
Organs At Risk ◽  
Lymph Node Status ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Proton Radiotherapy ◽  
Regional Lymph Nodes ◽  
Deep Inspiration Breath Hold

AbstractWe report on a comparative dosimetrical study between deep inspiration breath hold (DIBH) and shallow breathing (SB) in prone crawl position for photon and proton radiotherapy of whole breast (WB) and locoregional lymph node regions, including the internal mammary chain (LN_MI). We investigate the dosimetrical effects of DIBH in prone crawl position on organs-at-risk for both photon and proton plans. For each modality, we further estimate the effects of lung and heart doses on the mortality risks of different risk profiles of patients. Thirty-one patients with invasive carcinoma of the left breast and pathologically confirmed positive lymph node status were included in this study. DIBH significantly decreased dose to heart for photon and proton radiotherapy. DIBH also decreased lung doses for photons, while increased lung doses were observed using protons because the retracting heart is displaced by low-density lung tissue. For other organs-at-risk, DIBH resulted in significant dose reductions using photons while minor differences in dose deposition between DIBH and SB were observed using protons. In patients with high risks for cardiac and lung cancer mortality, average thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 3.12% (photon DIBH), 4.03% (photon SB), 1.80% (proton DIBH) and 1.66% (proton SB). The radiation-related mortality risk could not outweigh the ~ 8% disease-specific survival benefit of WB + LN_MI radiotherapy in any of the assessed treatments.

Deep-inspiration breath hold radiotherapy in patients with left-sided breast cancer after partial mastectomy

2021 ◽  
Vol 100 (4) ◽  
Keyword(s):  
Breast Cancer ◽  
Radiation Dose ◽  
Organs At Risk ◽  
Left Lung ◽  
Free Breathing ◽  
Partial Mastectomy ◽  
Breath Hold ◽  
Deep Inspiration ◽  
Deep Inspiration Breath Hold ◽  
Dose Volume Histograms

Introduction: The purpose of this study was to compare the radiation dose to organs at risk for deep-inspiration breath hold (DIBH) and free-breathing (FB) radiotherapy in patients with lef-sided breast cancer undergoing adjuvant radiotherapy after partial mastectomy. Methods: One hundred patients with left-sided breast cancer underwent DIBH and FB planning computed tomography scans, and the 2 techniques were compared. Dose-volume histograms were analyzed for heart, left anterior descending coronary artery (LAD), and left lung. Results: Radiation dose to heart, LAD, and left lung was significantly lower for DIBH than for free breathing plans. The median mean heart dose for DIBH technique in comparison with FB was 1.21 Gy, and 3.22 Gy respectively; for LAD, 4.67 versus 24.71 Gy; and for left lung 8.32 Gy versus 9.99 Gy. Conclusion: DIBH is an effective technique to reduce cardiac and lung radiation exposure.

scholarly journals Proton Radiotherapy Could Reduce the Risk of Fatal Second Cancers for Children with Intracranial Tumors in Low- and Middle-Income Countries

2021 ◽  
Vol 7 (4) ◽  
pp. 1-10
Author(s):  
Kyle J. Gallagher ◽  
Bassem Youssef ◽  
Rola Georges ◽  
Anita Mahajan ◽  
Joelle Ann Feghali ◽  
...  
Keyword(s):  
At Risk ◽  
Proton Therapy ◽  
Pediatric Patients ◽  
Income Country ◽  
High Income Country ◽  
Intracranial Tumors ◽  
Proton Radiotherapy ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Purpose To test our hypothesis that, for young children with intracranial tumors, proton radiotherapy in a high-income country does not reduce the risk of a fatal subsequent malignant neoplasm (SMN) compared with photon radiotherapy in low- and middle-income countries. Materials and Methods We retrospectively selected 9 pediatric patients with low-grade brain tumors who were treated with 3-dimensional conformal radiation therapy in low- and middle-income countries. Images and contours were deidentified and transferred to a high-income country proton therapy center. Clinically commissioned treatment planning systems of each academic hospital were used to calculate absorbed dose from the therapeutic fields. After fusing supplemental computational phantoms to the patients' anatomies, models from the literature were applied to calculate stray radiation doses. Equivalent doses were determined in organs and tissues at risk of SMNs, and the lifetime attributable risk of SMN mortality (LAR) was predicted using a dose-effect model. Our hypothesis test was based on the average of the ratios of LARs from proton therapy to that of photon therapy ()(H0: = 1; HA: < 1). Results Proton therapy reduced the equivalent dose in organs at risk for SMNs and LARs compared with photon therapy for which the for the cohort was 0.69 ± 0.10, resulting in the rejection of H0 (P < .001, α = 0.05). We observed that the younger children in the cohort (2-4 years old) were at a factor of approximately 2.5 higher LAR compared with the older children (8-12 years old). Conclusion Our findings suggest that proton radiotherapy has the strong potential of reducing the risk of fatal SMNs in pediatric patients with intracranial tumors if it were made available globally.

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