• Something wrong with this record ?

Risk of Pneumonitis and Outcomes After Mediastinal Proton Therapy for Relapsed/Refractory Lymphoma: A PTCOG and PCG Collaboration

YD. Tseng, BS. Hoppe, K. Dedeckova, CG. Patel, CE. Hill-Kayser, DM. Miller, A. Maity, NP. Mendenhall, RB. Mailhot Vega, TI. Yock, S. Baliga, CB. Hess, KM. Winkfield, P. Mohindra, LR. Rosen, H. Tsai, J. Chang, WF. Hartsell, JP. Plastaras

. 2021 ; 109 (1) : 220-230. [pub] 20200828

Language English Country United States

Document type Clinical Trial, Journal Article

Persistent link   https://www.medvik.cz/link/bmc21019551

PURPOSE: Despite high response rates, there has been reluctance to use radiation therapy for patients with relapsed/refractory (r/r) Hodgkin (HL) or aggressive non-Hodgkin lymphoma (NHL) given concerns for subacute and late toxicities. Symptomatic pneumonitis, a subacute toxicity, has an incidence of 17% to 24% (≥grade 2) even with intensity modulated radiation therapy. Proton therapy (PT), which has no exit radiation dose, is associated with a lower dose to lung compared with other radiation techniques. As risk of radiation pneumonitis is associated with lung dose, we evaluated whether pneumonitis rates are lower with PT. METHODS AND MATERIALS: Within an international, multi-institutional cohort, we retrospectively evaluated the incidence and grade of radiation pneumonitis (National Cancer Institute Common Terminology Criteria for Adverse Events v4) among patients with r/r HL or NHL treated with PT. RESULTS: A total of 85 patients with r/r lymphoma (66% HL, 34% NHL; 46% primary chemorefractory) received thoracic PT from 2009 to 2017 in the consolidation (45%) or salvage (54%) setting. Median dose was 36 Gy(RBE). Before PT, patients underwent a median of 1 salvage systemic therapy (range, 0-4); 40% received PT within 4 months of transplant. With a median follow-up of 26.3 months among living patients, 11 patients developed symptomatic (grade 2) pneumonitis (12.8%). No grade 3 or higher pneumonitis was observed. Dose to lung, including mean lung dose, lung V5, and V20, significantly predicted risk of symptomatic pneumonitis, but not receipt of brentuximab, history of bleomycin toxicity, sex, or peritransplant radiation. CONCLUSIONS: PT for relapsed/refractory lymphoma was associated with favorable rates of pneumonitis compared with historical controls. We confirm that among patients treated with PT, pneumonitis risk is associated with mean lung and lung V20 dose. These findings highlight how advancements in radiation delivery may improve the therapeutic ratio for patients with relapsed/refractory lymphoma. PT may be considered as a treatment modality for patients with relapsed/refractory lymphoma in the consolidation or salvage setting.

References provided by Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc21019551
003      
CZ-PrNML
005      
20210830101138.0
007      
ta
008      
210728s2021 xxu f 000 0|eng||
009      
AR
024    7_
$a 10.1016/j.ijrobp.2020.08.055 $2 doi
035    __
$a (PubMed)32866566
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a xxu
100    1_
$a Tseng, Yolanda D $u Department of Radiation Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Proton Collaborative Group Registry Membership Site, Warrenville, Illinois. Electronic address: ydt2@uw.edu
245    10
$a Risk of Pneumonitis and Outcomes After Mediastinal Proton Therapy for Relapsed/Refractory Lymphoma: A PTCOG and PCG Collaboration / $c YD. Tseng, BS. Hoppe, K. Dedeckova, CG. Patel, CE. Hill-Kayser, DM. Miller, A. Maity, NP. Mendenhall, RB. Mailhot Vega, TI. Yock, S. Baliga, CB. Hess, KM. Winkfield, P. Mohindra, LR. Rosen, H. Tsai, J. Chang, WF. Hartsell, JP. Plastaras
520    9_
$a PURPOSE: Despite high response rates, there has been reluctance to use radiation therapy for patients with relapsed/refractory (r/r) Hodgkin (HL) or aggressive non-Hodgkin lymphoma (NHL) given concerns for subacute and late toxicities. Symptomatic pneumonitis, a subacute toxicity, has an incidence of 17% to 24% (≥grade 2) even with intensity modulated radiation therapy. Proton therapy (PT), which has no exit radiation dose, is associated with a lower dose to lung compared with other radiation techniques. As risk of radiation pneumonitis is associated with lung dose, we evaluated whether pneumonitis rates are lower with PT. METHODS AND MATERIALS: Within an international, multi-institutional cohort, we retrospectively evaluated the incidence and grade of radiation pneumonitis (National Cancer Institute Common Terminology Criteria for Adverse Events v4) among patients with r/r HL or NHL treated with PT. RESULTS: A total of 85 patients with r/r lymphoma (66% HL, 34% NHL; 46% primary chemorefractory) received thoracic PT from 2009 to 2017 in the consolidation (45%) or salvage (54%) setting. Median dose was 36 Gy(RBE). Before PT, patients underwent a median of 1 salvage systemic therapy (range, 0-4); 40% received PT within 4 months of transplant. With a median follow-up of 26.3 months among living patients, 11 patients developed symptomatic (grade 2) pneumonitis (12.8%). No grade 3 or higher pneumonitis was observed. Dose to lung, including mean lung dose, lung V5, and V20, significantly predicted risk of symptomatic pneumonitis, but not receipt of brentuximab, history of bleomycin toxicity, sex, or peritransplant radiation. CONCLUSIONS: PT for relapsed/refractory lymphoma was associated with favorable rates of pneumonitis compared with historical controls. We confirm that among patients treated with PT, pneumonitis risk is associated with mean lung and lung V20 dose. These findings highlight how advancements in radiation delivery may improve the therapeutic ratio for patients with relapsed/refractory lymphoma. PT may be considered as a treatment modality for patients with relapsed/refractory lymphoma in the consolidation or salvage setting.
650    _2
$a mladiství $7 D000293
650    _2
$a dospělí $7 D000328
650    _2
$a senioři $7 D000368
650    _2
$a dítě $7 D002648
650    _2
$a ženské pohlaví $7 D005260
650    _2
$a lidé $7 D006801
650    _2
$a lymfom $x radioterapie $7 D008223
650    _2
$a mužské pohlaví $7 D008297
650    12
$a mediastinum $7 D008482
650    _2
$a lidé středního věku $7 D008875
650    _2
$a protonová terapie $x škodlivé účinky $7 D061766
650    _2
$a radiační pneumonitida $x etiologie $7 D017564
650    _2
$a recidiva $7 D012008
650    _2
$a rizikové faktory $7 D012307
650    _2
$a výsledek terapie $7 D016896
650    _2
$a mladý dospělý $7 D055815
655    _2
$a klinické zkoušky $7 D016430
655    _2
$a časopisecké články $7 D016428
700    1_
$a Hoppe, Bradford S $u Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
700    1_
$a Dedeckova, Katerina $u Proton Therapy Center Czech, Prague
700    1_
$a Patel, Chirayu G $u Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
700    1_
$a Hill-Kayser, Christine E $u Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
700    1_
$a Miller, David M $u Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
700    1_
$a Maity, Amit $u Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
700    1_
$a Mendenhall, Nancy P $u Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
700    1_
$a Mailhot Vega, Raymond B $u Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
700    1_
$a Yock, Torunn I $u Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
700    1_
$a Baliga, Sujith $u Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
700    1_
$a Hess, Clayton B $u Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
700    1_
$a Winkfield, Karen M $u Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
700    1_
$a Mohindra, Pranshu $u Proton Collaborative Group Registry Membership Site, Warrenville, Illinois; Department of Radiation Oncology, University of Maryland School of Medicine and Maryland Proton Treatment Center, Baltimore, Maryland
700    1_
$a Rosen, Lane R $u Department of Radiation Oncology, Willis-Knighton Cancer Center, Shreveport, Lousiana
700    1_
$a Tsai, Henry $u Proton Collaborative Group Registry Membership Site, Warrenville, Illinois; Procure Proton Therapy Center, Somerset, New Jersey
700    1_
$a Chang, John $u Proton Collaborative Group Registry Membership Site, Warrenville, Illinois; Oklahoma Proton Center, Oklahoma City, Oklahoma
700    1_
$a Hartsell, William F $u Proton Collaborative Group Registry Membership Site, Warrenville, Illinois; Northwestern Medicine Proton Center, Warrenville, Illinois
700    1_
$a Plastaras, John P $u Department of Radiation Oncology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
773    0_
$w MED00002371 $t International journal of radiation oncology, biology, physics $x 1879-355X $g Roč. 109, č. 1 (2021), s. 220-230
856    41
$u https://pubmed.ncbi.nlm.nih.gov/32866566 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y p $z 0
990    __
$a 20210728 $b ABA008
991    __
$a 20210830101138 $b ABA008
999    __
$a ok $b bmc $g 1690393 $s 1139997
BAS    __
$a 3
BAS    __
$a PreBMC
BMC    __
$a 2021 $b 109 $c 1 $d 220-230 $e 20200828 $i 1879-355X $m International journal of radiation oncology, biology, physics $n Int J Radiat Oncol Biol Phys $x MED00002371
LZP    __
$a Pubmed-20210728

Find record

Citation metrics

Archiving options