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Outcomes of Proton Therapy to Infradiaphragmatic Sites in Pediatric Patients with Hodgkin Lymphoma
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  • Cecilia Jiang,
  • Michele Kim,
  • Xiaoyan Han,
  • Monica Chelius,
  • Travis Hoover,
  • Leslie Kersun,
  • Anne F. Reilly,
  • Harper Hubbeling,
  • Elizabeth Cummings,
  • Goldie Kurtz,
  • Christine Hill-Kayser,
  • John Plastaras,
  • Michael LaRiviere
Cecilia Jiang
University of Pennsylvania Department of Radiation Oncology
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Michele Kim
University of Pennsylvania Department of Radiation Oncology
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Xiaoyan Han
University of Pennsylvania Department of Biostatistics and Epidemiology
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Monica Chelius
University of Pennsylvania Department of Radiation Oncology
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Travis Hoover
University of Maryland
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Leslie Kersun
The Children's Hospital of Philadelphia
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Anne F. Reilly
The Children's Hospital of Philadelphia
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Harper Hubbeling
University of Pennsylvania Department of Radiation Oncology
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Elizabeth Cummings
University of Pennsylvania Department of Radiation Oncology
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Goldie Kurtz
University of Pennsylvania Department of Radiation Oncology
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Christine Hill-Kayser
University of Pennsylvania Department of Radiation Oncology
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John Plastaras
University of Pennsylvania Department of Radiation Oncology
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Michael LaRiviere
University of Pennsylvania Department of Radiation Oncology

Corresponding Author:[email protected]

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Abstract

Background: Proton therapy (PT) has potential advantages in pediatric Hodgkin lymphoma (pHL). However, there is limited data on PT, specifically to infradiaphragmatic targets. We report on PT planning details, doses achieved to organs at risk (OARs), and clinical and toxicity outcomes for patients with pHL who received PT to infradiaphragmatic regions. Methods: This is a retrospective study including patients treated between 2011-2022. Demographic and clinical factors were collected, and toxicity was reported using CTCAE version 5.0. Dosimetric and clinical factors associated with key outcomes were assessed via Cox regression. Photon plans were generated for all patients, and the paired t-test or Wilcoxon signed rank sum test were used for dosimetric comparisons. Results: Twenty-one patients comprising 22 PT courses were included. Median follow-up was 5.0 years and mean age was 14.2 years. Median dose was 21 Gray equivalent (GyE) over 14 fractions. Top acute grade 1 (G1) toxicities included fatigue (59%) and anorexia (36%). Rates of acute G2 and G3+ toxicity were 18% and 0%, respectively. After PT, no local or marginal failures occurred. 5% experienced disease progression which were all successfully salvaged, and all patients were alive and disease-free at last follow-up. No secondary malignancies developed. Compared to photon radiation, PT achieved significantly lower doses to the bowels, stomach, spleen, pancreatic tail, liver, and kidneys. Conclusions: PT is well-tolerated and leads to excellent oncologic and toxicity outcomes with long-term follow-up. PT confers dosimetric advantages when compared to photons.
Submitted to Pediatric Blood & Cancer
01 Apr 2024Submission Checks Completed
01 Apr 2024Assigned to Editor
23 Apr 2024Review(s) Completed, Editorial Evaluation Pending
27 Apr 2024Editorial Decision: Revise Major
25 Jul 20241st Revision Received
25 Jul 2024Submission Checks Completed
25 Jul 2024Assigned to Editor
26 Jul 2024Review(s) Completed, Editorial Evaluation Pending
26 Jul 2024Reviewer(s) Assigned
12 Aug 2024Editorial Decision: Accept