{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T16:17:19Z","timestamp":1769876239842,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,12]],"date-time":"2024-09-12T00:00:00Z","timestamp":1726099200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Proton therapy (PT) has potential advantages in pediatric Hodgkin lymphoma (pHL). However, there are limited data on PT, specifically to infradiaphragmatic targets. We report on PT planning details, doses achieved to organs at risk (OARs), and clinical and toxicity outcomes for patients with pHL who received PT to infradiaphragmatic regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective study including patients treated between 2011 and 2022. Demographic and clinical factors were collected, and toxicity was reported using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Dosimetric and clinical factors associated with key outcomes were assessed via Cox regression. Photon plans were generated for all patients, and the paired <jats:italic>t<\/jats:italic>\u2010tests or Wilcoxon signed rank sum tests were used for dosimetric comparisons.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010one patients comprising 22 PT courses were included. Median follow\u2010up was 5.0\u00a0years, and mean age was 14.2\u00a0years. Median dose was 21 Gray equivalent (GyE) over 14 fractions. Top acute grade 1 (G1) toxicities included fatigue (59%) and anorexia (36%). Rates of acute G2 and G3+ toxicity were 18% and 0%, respectively. After PT, no local or marginal failures occurred. Five percent experienced disease progression, who were all successfully salvaged, and all patients were alive and disease\u2010free at last follow\u2010up. No secondary malignancies developed. Compared to photon radiotherapy, PT achieved significantly lower doses to the bowels, stomach, spleen, pancreatic tail, liver, kidneys, and pelvic bones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PT is well\u2010tolerated and leads to excellent oncologic and toxicity outcomes with long\u2010term follow\u2010up. PT confers dosimetric advantages when compared to photons.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31290","type":"journal-article","created":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T04:19:41Z","timestamp":1726201181000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of proton therapy to infradiaphragmatic sites in pediatric patients with Hodgkin lymphoma"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1388-8910","authenticated-orcid":false,"given":"Cecilia","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyan","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Biostatics, Epidemiology, and Informatics Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monica","family":"Chelius","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Travis","family":"Hoover","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Maryland  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie","family":"Kersun","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne F.","family":"Reilly","sequence":"additional","affiliation":[{"name":"Division of Oncology The Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"},{"name":"Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harper","family":"Hubbeling","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Cummings","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goldie","family":"Kurtz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Hill\u2010Kayser","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4916-9857","authenticated-orcid":false,"given":"John P.","family":"Plastaras","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"LaRiviere","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,12]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"National Cancer Institute.Cancer stat facts: cancer among adolescents and young adults (AYAs) (ages 15\u201339).National Cancer Institute; Updated 2023. 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