Breast-Sparing Proton Therapy for Hodgkin's Disease (Breast Sparing)

Breast-Sparing Proton Therapy for Hodgkin's Disease in Young Females Demonstrated By Positron Emission Tomograpy (PET) Scanning: A Pilot Study

The purpose of this study is to drastically reduce unnecessary breast dose in young females with Hodgkin's Disease who require radiation therapy.

Study Overview

• Status: Terminated
• Conditions: Hodgkins Disease
• Intervention / Treatment: Radiation: Proton

Detailed Description

According to the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, there will be an estimated 8,490 new cases of Hodgkin's Lymphoma (HL) in the United States in 2010, with an estimated 1,320 deaths (Jemal, Siegel et al.). The unadjusted rates of 5 year overall survival are approximately 95%, and remain among the highest of all childhood and adult malignancies. With many children and young adults surviving into advanced age, the impetus has been to develop less toxic yet equally effective treatments. One of the main approaches taken over the last 25 years to minimize long-term treatment toxicity has been to limit the amount and volume of radiation received by patients. This pilot study continues along those lines, attempting to further refine the delivery of radiation therapy (RT) in order to avoid one of the most notorious long-term side-effects: secondary breast cancer.

Multiple studies investigating late toxicity in long-term survivors of pediatric Hodgkin's Lymphoma have shown the risk of breast cancer in young females receiving mediastinal radiation to be 50 times greater than their age-matched counterparts. The Late Effects Study Group, with a median follow-up of 17 years, reported a breast cancer incidence of 16% with a standardized incidence ratio of 55.5 (Bhatia, Yasui et al. 2003). Through utilization of breast-sparing proton therapy, we hope to provide young female patients with the benefits of radiation therapy while decreasing their risk of secondary breast cancer, thus increasing the therapeutic ratio.

In a prior computer-based, in-silico, dose planning study, utilizing the most basic beam orientation (a single PA beam), we showed that dose to breast tissue was reduced by a minimum of at least 80% with proton treatment compared to standard AP-PA photon treatment (in publication). Furthermore, dose to clinical target volume was maintained, and dose to other normal structures was statistically no worse. We now aim to validate these findings by verifying the beam range, in-vivo, via post-treatment combined Positron Emission Tomography-Computer Tomography (PET-CT) imaging in young females undergoing supra-diaphragmatic radiotherapy for Hodgkin's Disease.

• Study Type: Interventional
• Enrollment (Actual): 3
• Phase: Early Phase 1

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Bloomington, Indiana, United States, 47408
      • Indiana University Health Proton Therapy Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years to 30 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Female sex
• Age >/= 10 years old and < 30 years old
• Pathologically confirmed classical Hodgkin's Lymphoma
• At least one site of disease located above the diaphragm
• Signed study-specific consent prior to initiation of therapy
• Women of child-bearing potential must have a negative pregnancy blood test within 7 days of starting protocol therapy.

Exclusion Criteria:

• Previous radiation therapy to any part of the body.
• Parenchymal lung involvement at initial presentation or any patient that may need whole lung irradiation as per institutional guidelines.
• Lymphocyte predominant histology not eligible.

• Significant infection or other coexistent medical condition that would preclude protocol therapy such as:

  • History of HIV/AIDS
  • History of collagen Vascular Disease
  • Symptomatic congestive heart failure
  • Unstable angina pectoris or myocardial infarction within 6 months
  • Uncontrolled hypertension (systolic blood pressure > 160 mm Hg or diastolic blood pressure > 100 mm Hg on 2 consecutive measurements separated by 1 week).
  • History of uncontrolled diabetes
  • Psychiatric illness/social situations that would compromise patient safety or limit compliance with study requirements

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Radiation Treatment using Protons; 14 -24 Radiation Treatments (typically 1.5 - 1.8 cobalt-Gray equivalent per fraction for 14-24 treatments).	Radiation: Proton; 14-24 Radiation treatments using Protons; Other Names: Breast sparing using proton beams

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparative DVH data for delivered proton plan and accompanying photon plan for target volume and normal tissues.	Dose-volume histogram data from both the delivered proton plan and the accompanying photon plan for target volumes and normal tissues, including: • Breast, heart, lung, thyroid, parotid glands , esophagus, spinal cord, *liver, *kidneys,	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment toxicity and disease control of proton therapy for the treatment of pediatric Hodgkin's Lymphoma.	Acute toxicity as per CTCAE v4.0; Local, regional, and distal control of the disease at 3 years	3 - 60 Months

Collaborators and Investigators

• Sponsor: Indiana University
• Investigators: Principal Investigator: Jeffery Buchsbuam, MD, Indiana University

Study record dates

Study Major Dates

• Study Start: September 1, 2011
• Primary Completion (Actual): February 1, 2015
• Study Completion (Actual): February 1, 2015

Study Registration Dates

• First Submitted: April 19, 2012
• First Submitted That Met QC Criteria: February 21, 2014
• First Posted (Estimate): February 25, 2014

Study Record Updates

• Last Update Posted (Estimate): February 4, 2015
• Last Update Submitted That Met QC Criteria: February 3, 2015
• Last Verified: February 1, 2015

More Information

Terms related to this study

• Keywords: Hodgkins Disease in Young Females; Breast Sparing Radiation Treatments
• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Lymphoma; Hodgkin Disease
• Other Study ID Numbers: IUHPTC-01