Clinical Intensity Modulated Proton Therapy for Hodgkin Lymphoma: Which Patients Benefit the Most? Georgios Ntentas, DPhil, Katerina Dedeckova, MD, Michal.

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Clinical Intensity Modulated Proton Therapy for Hodgkin Lymphoma: Which Patients Benefit the Most? Georgios Ntentas, DPhil, Katerina Dedeckova, MD, Michal Andrlik, MSc, Marianne C. Aznar, PhD, Ben George, PhD, Jiří Kubeš, MD, PhD, Sarah C. Darby, PhD, David J. Cutter, FRCR, DPhil Practical Radiation Oncology Volume 9, Issue 3, Pages 179-187 (May 2019) DOI: 10.1016/j.prro.2019.01.006 Copyright © 2019 The Authors Terms and Conditions

Fig. 1 Dosimetric comparison: Mean dose to normal tissue and mean dose for various organs at risk for 3-dimensional conformal radiation therapy, partial arc volumetric modulated radiation therapy, and pencil beam scanning (PBS) proton therapy. **Significantly lower (P < .001) dose compared with PBS. *Significantly lower (P < .05) dose compared with PBS. Abbreviations: 3D-CRT = 3-dimensional conformal radiation therapy; PartArc = partial arc volumetric modulated; PBS = pencil beam scanning. Practical Radiation Oncology 2019 9, 179-187DOI: (10.1016/j.prro.2019.01.006) Copyright © 2019 The Authors Terms and Conditions

Fig. 2 Mean heart dose for 3-dimensional conformal radiation therapy, partial arc volumetric modulated radiation therapy, and pencil beam scanning (PBS) proton therapy according to clinical target volume thoracic level. **Significantly lower (P < .001) dose compared with PBS. *Significantly lower (P < .05) dose compared with PBS. Abbreviations: 3D-CRT = 3-dimensional conformal radiation therapy; PartArc = partial arc volumetric modulated; PBS = pencil beam scanning. Practical Radiation Oncology 2019 9, 179-187DOI: (10.1016/j.prro.2019.01.006) Copyright © 2019 The Authors Terms and Conditions

Fig. 3 Mean breast dose for 3-dimensional conformal radiation therapy, partial arc volumetric modulated radiation therapy, and pencil beam scanning (PBS) proton therapy for all female patients and patients with and without axillary involvement. **Significantly lower (P < .001) dose compared with PBS. *Significantly lower (P < .05) dose compared with PBS. Abbreviations: 3D-CRT = 3-dimensional conformal radiation therapy; PartArc = partial arc volumetric modulated; PBS = pencil beam scanning. Practical Radiation Oncology 2019 9, 179-187DOI: (10.1016/j.prro.2019.01.006) Copyright © 2019 The Authors Terms and Conditions

Fig. 4 Relationship between mean lung dose (MLD) and planning target volume (PTV, top panel) and among mean normal tissue dose and PTV (bottom panel) for 3-dimensional conformal radiation therapy (RT), partial arc volumetric modulated RT, and pencil beam scanning (PBS) proton therapy. The fitted regression models for MLD describing the three radiation therapy methods were 3-dimensional conformal RT (y = 0.002x + 7.5; P = .05), partial arc volumetric modulated RT (y = 0.002x + 5.8; P = .01), and pencil beam scanning (y = 0.0004x + 4.6; P = .44), where y is the MLD and x is the PTV. The fitted regression models for mean normal tissue dose were 3-dimensional conformal RT (y = 0.002x + 3.3; P = .005), partial arc volumetric modulated RT (y = 0.002x + 2.4; P < .011), and PBS (y = 0.0004x + 1.5; P = .16), where y is the normal tissue dose, and x is the PTV volume. P values indicate the significance of the trend in the linear regression model. Abbreviations: 3D-CRT = 3-dimensional conformal radiation therapy; PartArc = partial arc volumetric modulated; PBS = pencil beam scanning; PTV = planning target volume. Practical Radiation Oncology 2019 9, 179-187DOI: (10.1016/j.prro.2019.01.006) Copyright © 2019 The Authors Terms and Conditions