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Hodgkin lymphoma is a cancer of the lymph nodes that predominantly affects children and young adults. Every year in the United States, approximately 8,000 new cases are diagnosed. Ninety percent of patients who are treated with standard therapy (including chemotherapy followed by radiotherapy) are cured. Hodgkin lymphoma typically presents with a painless mass (usually in the lower neck), sometimes with fevers, night sweats, or unexplained weight loss.
Although most patients with Hodgkin lymphoma are cured, they develop many treatment side effects related to both chemotherapy and radiation. The Childhood Cancer Survivor Study identified Hodgkin lymphoma survivors as one of the groups at highest risk for developing severe or life-threatening chronic health conditions, specifically a subsequent cancer or heart disease. In fact, the two leading causes of death more than 15 years after completing treatment in Hodgkin lymphoma survivors are second cancers and heart disease. These increased risks in second cancers and heart disease are likely due to the late effects from chemotherapy (specifically bleomycin and adriamycin) as well as from radiotherapy. Since proton therapy is a more precise method of radiation therapy, it is likely to cause less heart disease and fewer second cancers than conventional radiation therapy.
Treating Hodgkin Lymphoma with Proton Therapy
At the University of Florida Proton Therapy Institute, we have demonstrated that proton therapy results in much less radiation to healthy tissues such as breast, lung, and heart. An example is shown below.
Figure A shows an axial CT scan slice through the heart (red) of a patient with Hodgkin lymphoma involving the mediastinum. On the left is the X-ray plan and on the right is the proton plan. The dark blue line in both represents the tumor and target area for the radiation. The green line represents the volume of the body receiving 95 percent of the total prescribed dose of radiation, while the light blue line reflects the volume of the body receiving 10 percent of the total prescribed radiation dose. As is apparent, with conventional radiation (left), the X-rays deposit more radiation in the heart and breasts than the proton plan. In fact, the proton plan reduced the mean dose to the heart by more than 50 percent and the mean dose to the breast by 70 percent. For this reason, it’s believed that Hodgkin lymphoma patients will have a much lower risk of heart disease and second malignancy with proton therapy than what’s been observed in the past with conventional radiation therapy.
Hodgkin Lymphoma Proton Therapy Protocol
Due to the reduction of normal tissue exposed to radiation with proton therapy, the University of Florida Proton Therapy Institute has an ongoing trial using proton therapy for patients with involvement of the mediastinum.
To learn more about treating Hodgkin lymphoma with proton therapy, or to find out if you are a candidate for proton therapy, contact the University of Florida Proton Therapy Institute today.