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10.04.2019 | Original Article

Consolidative mediastinal irradiation of malignant lymphoma using active scanning proton beams: clinical outcome and dosimetric comparison

verfasst von: Dr. med. Laila König, Dipl.-Inform. Med. Nina Bougatf, Dr. med. Juliane Hörner-Rieber, Naved Chaudhri, Thomas Mielke, Dr. sc. hum. Sebastian Klüter, Dr. med. Matthias Felix Haefner, Prof. Dr. med. Stefan Rieken, Prof. Dr. Thomas Haberer, Prof. Dr. med. Dr. rer. nat. Jürgen Debus, Prof. Dr. med. Klaus Herfarth

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 7/2019

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Abstract

Purpose

Current research approaches in lymphoma focus on reduction of therapy-associated long-term side effects. Especially in mediastinal lymphoma, proton beam radiotherapy (PT) may be a promising approach for reducing the dose to organs at risk (OAR).

Patients

In total, 20 patients were irradiated with active scanning PT at Heidelberg Ion Beam Therapy Center (HIT) between September 2014 and February 2017. For comparative analysis, additional photon irradiation plans with helical intensity-modulated radiotherapy (IMRT) were calculated and quantitative and qualitative dose evaluations were made for both treatment modalities. Toxicity and survival outcomes were evaluated.

Results

Clinical target volume coverage was comparable in both treatment modalities and did not significantly differ between IMRT and PT. Nevertheless, PT showed superiority regarding the homogeneity index (HI_PT = 1.041 vs. HI_IMRT = 1.075, p < 0.001). For all OAR, PT showed significantly higher dose reductions compared with IMRT. In particular, the dose to the heart was reduced in PT (absolute dose reduction of D_mean of 3.3 Gy [all patients] and 4.2 Gy [patients with pericardial involvement]). Likewise, the subgroup analysis of female patients, who were expected to receive higher doses to the breast, showed a higher dose reduction in D_mean of 1.2 Gy (right side) and 2.2 Gy (left side). After a median follow-up of 32 months (range 21–48 months), local and distant progression free survival (LPFS and DPFS) were 95.5% and 95.0%, respectively. Radiotherapy was tolerated well with only mild (grade 1–2) radiation-induced acute and chronic side effects.

Conclusion

A significant reduction in the dose to the surrounding OAR was achieved with PT compared with photon irradiation, without compromising target volume coverage. Dosimetric advantages may have the potential to translate into a reduction of long-term radiation-induced toxicity in young patients with malignant lymphoma of the mediastinum.

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Titel: Consolidative mediastinal irradiation of malignant lymphoma using active scanning proton beams: clinical outcome and dosimetric comparison
verfasst von: Dr. med. Laila König
Dipl.-Inform. Med. Nina Bougatf
Dr. med. Juliane Hörner-Rieber
Naved Chaudhri
Thomas Mielke
Dr. sc. hum. Sebastian Klüter
Dr. med. Matthias Felix Haefner
Prof. Dr. med. Stefan Rieken
Prof. Dr. Thomas Haberer
Prof. Dr. med. Dr. rer. nat. Jürgen Debus
Prof. Dr. med. Klaus Herfarth
Publikationsdatum: 10.04.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 7/2019
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01460-7

Springer Medizin

Consolidative mediastinal irradiation of malignant lymphoma using active scanning proton beams: clinical outcome and dosimetric comparison