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 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 Adult patients
ABVE-PC chemotherapy – 79%
Median RT dose- 21 Gy (RBE) ( Gy)
Adult patients
ABVD chemotherapy – 88%
Median RT dose 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