Dosimetric comparison of involved-field three-dimensional conformal photon radiotherapy and breast-sparing proton therapy for the treatment of Hodgkin's lymphoma in female pediatric patients

Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e667-71. doi: 10.1016/j.ijrobp.2011.01.061. Epub 2011 Apr 1.


Purpose: To assess the potential reduction in breast dose for young girls with Hodgkin's lymphoma (HL) treated with breast-sparing proton therapy (BS-PT) as compared with three-dimensional conformal involved-field photon radiotherapy (3D-CRT).

Methods and materials: The Clarian Health Cancer Registry was queried for female pediatric patients with the diagnosis of HL who received radiotherapy at the Indiana University Simon Cancer Center during 2006-2009. The original CT simulation images were obtained, and 3D-CRT and BS-PT plans delivering 21 Gy or cobalt gray equivalent (CGE) in 14 fractions were created for each patient. Dose-volume histogram data were collected for both 3D-CRT and BS-PT plans and compared by paired t test for correlated samples.

Results: The cancer registry provided 10 female patients with Ann Arbor Stage II HL, aged 10-18 years at the time of treatment. Both mean and maximum breast dose were significantly less with BS-PT compared with 3D-CRT: 0.95 CGE vs. 4.70 Gy (p < 0.001) and 21.07 CGE vs. 23.11 Gy (p < 0.001), respectively. The volume of breast receiving 1.0 Gy/CGE and 5.0 Gy/CGE was also significantly less with BS-PT, 194 cm(3) and 93 cm(3), respectively, compared with 790 cm(3) and 360 cm(3) with 3D-CRT (p = 0.009, 0.013).

Conclusion: Breast-sparing proton therapy has the potential to reduce unnecessary breast dose in young girls with HL by as much as 80% relative to involved-field 3D-CRT.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Breast / radiation effects*
  • Child
  • Female
  • Hodgkin Disease / pathology
  • Hodgkin Disease / radiotherapy*
  • Humans
  • Indiana
  • Neoplasm Staging
  • Organ Sparing Treatments / methods*
  • Organs at Risk / radiation effects
  • Photons / adverse effects
  • Photons / therapeutic use
  • Proton Therapy*
  • Protons / adverse effects
  • Radiation Injuries / prevention & control*
  • Radiotherapy Dosage
  • Radiotherapy, Conformal / adverse effects
  • Radiotherapy, Conformal / methods*
  • Registries / statistics & numerical data


  • Protons