Proton therapy in the management of non-Hodgkin lymphoma

Figures & data

Table I. Patient and tumor characteristics.

Patient no.	Age (years)	Histology	Site	Stage	Chemotherapy	Role of proton treatment	Radiotherapy dose	Follow-up (months)	Status
1	56	Follicular	Orbit	I	None	Definitive	24 Gy (RBE) in 1.5 fx	57	NED
2	53	Follicular	Orbit	IV	None (previously on rituximab)	Definitive	24 Gy (RBE) in 1.5 fx	45	AWD
3	48	MALT	Orbit	I	None	Definitive	30.6 Gy (RBE) in 1.8 fx	68	NED
4	56	MALT	Orbit	I	None	Definitive	30.6 Gy (RBE) in 1.8 fx	72	NED
5	36	DLBCL	Mediastinum	IA (bulky)	R-CHOP × 6c with CR	Consolidative	36 Gy (RBE) in 1.5 fx	38	NED
6	24	DLBCL	Mediastinum	IIB (bulky)	R-CHOP × 6c with CR	Consolidative	30.6 Gy (RBE) in 1.8 fx	10	NED
7	19	DLBCL	Mediastinum	IIA	Initial: R-CHOP × 6c. Second line: R-ICE × 2c followed by R-ESHAP × 2c, high-dose chemotherapy and autologous stem cell transplant ≥ residual biopsy + disease in prevascular space	Consolidative	41.4 Gy (RBE) in 1.8 fx	36	NED
8	42	Plasmablastic	Stomach and left adrenal gland	IV	Hyper-CVAD × 8c	Consolidative	36 Gy (RBE) in 2 fx	25	NED
9	66	Plasmablastic	Base of skull and paranasal sinuses	IV	CHOP × 6c + gitoxin, then intrathecal methotrexate	Consolidative	60 Gy (RBE) in 1.2 fx BID	53	Died of second cancer
10	4	NK T-cell	Oropharynx, hard palate and hypopharynx	IIE	SMILE × 2c pre- and post-proton therapy (4c total)	Definitive	50.4 Gy (RBE) in 1.8 fx	6	NED
11	57	NK T-cell	Infratemporal fossa, orbit and cavernous sinus	IV	CHOP × 3c	Definitive	59.6 Gy (RBE) in 1.2 fx BID plus 2 Gy × 1	7	Local progression, died

MALT, mucosa-associated lymphoid tissue; DLBCL, diffuse large B-cell lymphoma; CVAD, cyclophosphamide, vincristine, doxorubicin and dexamethasone; NK, natural killer; R-CHOP, rituximab, cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine and prednisolone; c, cycles; CR, complete response; R-ICE, rituximab, carboplatin and etoposide; R-ESHAP, rituximab, etoposide, methylprednisolone, cytarabine and cisplatin; Hyper-CVAD, hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone; SMILE, dexamethasone, methotrexate, ifosfamide, l-asparaginase and etoposide; RBE, relative biological effectiveness; fx, fractions; BID, twice daily; NED, no evidence of disease; AWD, alive with disease.

Table II. Acute and late radiation associated toxicities.

	Acute				Late
	Grade 1	Grade 2	Grade 3	Grade 4	Grade 1	Grade 2	Grade 3	Grade 4
Skin	4	6	0	0	9	0	0	0
Fatigue	6	0	0	0	2	0	0	0
Nausea/vomiting	3	0	0	0	0	0	0	0
Esophagitis	3	0	1	0	1	0	0	0
Xerostomia	2	0	0	0	1	0	0	0
Mucositis	2	0	0	0	0	0	0	0
Weight loss	0	1	0	0	0	0	0	0
Cough/dyspnea	2	0	0	0	1	0	0	0
Dyspepsia	1	0	0	0	0	0	0	0
Cataracts	0	0	0	0	0	0	3	0
Epiphora	0	0	0	0	1	0	0	0
Dry eye	0	0	0	0	0	1	0	0
Dermatitis	1	6	0	0	0	0	0	0
Alopecia	2	0	0	0	0	0	0	0
Headache	1	1	0	0	0	0	0	0
Anxiety/depression	1	0	0	0	1	0	0	0
Dysphagia	0	0	1	0	0	0	0	0
Dysarthria	1	0	0	0	1	0	0	0
Anorexia	0	1	0	0	0	0	0	0
Tinnitus	0	0	0	0	1	0	0	0
Otalgia	0	0	0	0	1	0	0	0
Hypothyroidism	0	0	0	0	1	0	0	0