Consolidative Proton Therapy after Chemotherapy for Patients with Hodgkin Lymphoma

Abstract

Background: We investigated early outcomes for patients receiving chemotherapy followed by consolidative proton therapy (PT) for the treatment of Hodgkin lymphoma (HL).Patients and Methods: 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%), while 37% had B symptoms. The median follow-up was 32 months (range, 5–92 months).Results: 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 PET/CT scan response at the end of chemotherapy, patients with a partial response had worse 3-year progression-free survival compared with other patients (78% vs. 94%; p = 0.0034). No grade 3 radiation-related toxicities have occurred to date.Conclusion: 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.

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