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Bradford Hoppe MD, MPH William Hartsell, MD

Bradford Hoppe MD, MPH William Hartsell, MD. Proton Therapy Patterns-of-Care and Early Outcomes for Hodgkin Lymphoma: Results from the Proton Collaborative Group Registry. Background. Hodgkin lymphoma survivors are at the highest risk of late complications among cancer survivors. CCSS-.

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Bradford Hoppe MD, MPH William Hartsell, MD

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  1. Bradford Hoppe MD, MPH William Hartsell, MD Proton Therapy Patterns-of-Care and Early Outcomes for Hodgkin Lymphoma: Results from the Proton Collaborative Group Registry

  2. Background • Hodgkin lymphoma survivors are at the highest risk of late complications among cancer survivors CCSS-

  3. Background • Radiation oncology • Reduce the radiation dose • Reduce the radiation field size • Utilize more conformal radiation techniques

  4. 3D-CRT IMRT Protons

  5. 3D-CRT IMRT Protons

  6. 3D-CRT IMRT Protons

  7. Background • Limited data exists utilizing conformal techniques • IMRT- 3 studies (N=140 patients) • Proton Therapy- 2 studies (N=20 patients)

  8. Purpose • Evaluate patients receiving proton therapy for Hodgkin lymphoma and describe the early results

  9. Registry Evaluation Tracking Project: A Prospective Chart Review of Patients Treated with Radiation Therapy (REG001-09)

  10. Methods • Utilized the registry to identify patients treated with chemotherapy followed by consolidative proton therapy between June 2008 and March 2015. Identified 40 patients • 50 patients treated for HL • Excluded 8 relapse/refractory patients. • Excluded 1 patient with composite NHL/HL. • Excluded 1 patient with just a proton boost.

  11. Results • Patient characteristics • Median age was 21 years old • 36% were pediatric (<19 years old) • 80% were under 30 years old • 48% were female

  12. Results • Disease Characteristics • 68% Stage I/II • 32% Stage III/IV • 93% Mediastinal involvement • 65% Bulky disease • 48% B symptoms • Risk stratification • 23% Early Favorable (IA/IIA) • 45%- Early Unfavorable (I/II B or X) • 33%- Advanced Stage (III, IV)

  13. Results • Treatment Characteristics • Pediatric patients • ABVE-PC chemotherapy – 79% • Median RT dose- 21 Gy (RBE) (21-25.5 Gy) • Adult patients • ABVD chemotherapy – 88% • Median RT dose- 30.6 Gy (RBE) (21-36 Gy) • All patients treated with ISRT field design

  14. Results • Median follow up 21 months (range 4-47) • 2 year progression-free survival 85%

  15. Pattern of Relapse • 3 relapses • 2 in-field in bulky mediastinum after 21 Gy • 1 out-of-field in cervical neck after receiving 30 Gy to the mediastinum. • Would have been outside a photon field

  16. Toxicity • No grade 3 toxicities

  17. Conclusions • Consolidative proton therapy following standard chemotherapy in HL is primarily used in young patients with bulky mediastinal disease • Early relapse-free survival rates are similar to those reported with photons • Longer follow up is needed to assess late toxicities.

  18. Acknowledgement • Brad Hoppe • William Hartsell MD • Henry Tsai MD • Gary Larson MD • George Laramore MD, PHD • Carlos Vargas MD • Yolanda Tseng MD • Megan Dunn PhD • Lisa McGee MD • Oren Cahlon MD

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