{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T15:12:15Z","timestamp":1779894735838,"version":"3.53.1"},"reference-count":18,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Because proton beam therapy (PBT) can lower the dose of radiation to the heart, lungs, and breast, it is an established radiation modality for patients with Hodgkin lymphoma (HL). Pencil beam scanning (PBS) PBT facilitates the treatment of more extensive targets. This may be especially of value for lymphoma patients who require RT to both mediastinal and axillary targets, defined here as extended target RT (ETRT), given the target distribution and need to minimize the lung, heart, and breast dose. Using the Proton Collaborative Group registry, we identified patients with HL treated with PBT to both their mediastinum and axilla, for which DICOM-RT was available. All patients were treated with PBS. To evaluate the dosimetric impact of PBS, we compared delivered PBS plans with VMAT butterfly photon plans optimized to have the same target volume coverage, when feasible. Between 2016 and 2021, twelve patients (median 26 years) received PBS ETRT (median 30.6 Gy (RBE)). Despite the large superior\/inferior (SI, median 22.2 cm) and left\/right (LR, median 22.8 cm) extent of the ETRT targets, all patients were treated with one isocenter except for two patients (both with SI and LR &gt; 30 cm). Most commonly, anterior beams, with or without posterior beams, were used. Compared to photons, PBS had greater target coverage, better conformity, and lower dose heterogeneity while achieving lower doses to the lungs and heart, but not to the breast. No acute grade 3+ toxicities were reported, including pneumonitis. Proton ETRT in this small cohort was safely delivered with PBS and was associated with an improved sparing of the heart and lungs compared to VMAT.<\/jats:p>","DOI":"10.3390\/cancers16152736","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T08:14:46Z","timestamp":1722500086000},"page":"2736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Proton Pencil Beam Scanning Facilitates the Safe Treatment of Extended Radiation Targets for Hodgkin Lymphoma: A Report from the Proton Collaborative Group Registry"],"prefix":"10.3390","volume":"16","author":[{"given":"Maryam","family":"Ebadi","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, University of Washington and Radiation Oncology Division, Fred Hutch Cancer Center, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Pankuch","sequence":"additional","affiliation":[{"name":"Northwestern Medicine Proton Center, Warrenville, IL 60555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Boyer","sequence":"additional","affiliation":[{"name":"Northwestern Medicine Proton Center, Warrenville, IL 60555, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Chang","sequence":"additional","affiliation":[{"name":"The Oklahoma Proton Center, Oklahoma City, OK 73142, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Corewell Health William Beaumont University Hospital, Royal Oak, MI 48073, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8768-3577","authenticated-orcid":false,"given":"Matthew D.","family":"Hall","sequence":"additional","affiliation":[{"name":"Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaakir","family":"Hasan","sequence":"additional","affiliation":[{"name":"New York Proton Center, New York, NY 10035, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Bates","sequence":"additional","affiliation":[{"name":"Emory University Hospital Midtown, Atlanta, GA 30308, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Flampouri","sequence":"additional","affiliation":[{"name":"Emory School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-8841","authenticated-orcid":false,"given":"Adam J.","family":"Kole","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4873-7496","authenticated-orcid":false,"given":"Pranshu","family":"Mohindra","sequence":"additional","affiliation":[{"name":"University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Rossi","sequence":"additional","affiliation":[{"name":"California Protons Cancer Therapy Center, San Diego, CA 92121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parag","family":"Sanghvi","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, La Jolla, CA 92093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"McGee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaker","family":"Rana","sequence":"additional","affiliation":[{"name":"Maryland Proton Treatment Center, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4070-346X","authenticated-orcid":false,"given":"Yolanda D.","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Washington and Radiation Oncology Division, Fred Hutch Cancer Center, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.radonc.2022.10.003","article-title":"Systematic Review for Deep Inspiration Breath Hold in Proton Therapy for Mediastinal Lymphoma: A PTCOG Lymphoma Subcommittee Report and Recommendations","volume":"177","author":"Patel","year":"2022","journal-title":"Radiother. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.ijrobp.2017.05.004","article-title":"Evidence-Based Review on the Use of Proton Therapy in Lymphoma From the Particle Therapy Cooperative Group (PTCOG) Lymphoma Subcommittee","volume":"99","author":"Tseng","year":"2017","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.ijrobp.2021.10.151","article-title":"Proton Therapy in Supradiaphragmatic Lymphoma: Predicting Treatment-Related Mortality to Help Optimize Patient Selection","volume":"112","author":"Ntentas","year":"2022","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1182\/blood-2018-03-837633","article-title":"Proton Therapy for Adults with Mediastinal Lymphomas: The International Lymphoma Radiation Oncology Group Guidelines","volume":"132","author":"Dabaja","year":"2018","journal-title":"Blood"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1200\/JCO.2016.68.6394","article-title":"Early Positron Emission Tomography Response-Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized EORTC\/LYSA\/FIL H10 Trial","volume":"35","author":"Girinsky","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1056\/NEJMoa1408648","article-title":"Results of a Trial of PET-Directed Therapy for Early-Stage Hodgkin\u2019s Lymphoma","volume":"372","author":"Radford","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.ijrobp.2014.07.003","article-title":"Intensity Modulated Proton Therapy for Craniospinal Irradiation: Organ-at-Risk Exposure and a Low-Gradient Junctioning Technique","volume":"90","author":"Stoker","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijrobp.2014.05.029","article-title":"Supine Craniospinal Irradiation Using a Proton Pencil Beam Scanning Technique without Match Line Changes for Field Junctions","volume":"90","author":"Lin","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/COC.0000000000000819","article-title":"Selection of Mediastinal Lymphoma Patients for Proton Therapy within the Proton Collaborative Group Registry Concordance with the ILROG Guidelines","volume":"44","author":"Tseng","year":"2021","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_10","unstructured":"National Cancer Institute (2017). Common Terminology Criteria for Adverse Events (CTCAE) v5.0."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/1748-717X-9-94","article-title":"Dosimetric Advantages of a \u201c Butterfly\u201d Technique for Intensity-Modulated Radiation Therapy for Young Female Patients with Mediastinal Hodgkin\u2019s Lymphoma","volume":"9","author":"Voong","year":"2014","journal-title":"Radiat. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/jnci\/94.3.182","article-title":"Lung Cancer Following Chemotherapy and Radiotherapy for Hodgkin\u2019s Disease","volume":"94","author":"Travis","year":"2002","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1200\/JCO.2015.63.4444","article-title":"Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma","volume":"34","author":"Schaapveld","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.ijrobp.2011.05.078","article-title":"Predictive Factors for Radiation Pneumonitis in Hodgkin Lymphoma Patients Receiving Combined-Modality Therapy","volume":"83","author":"Fox","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.ijrobp.2015.02.010","article-title":"Predictors of Radiation Pneumonitis in Patients Receiving Intensity Modulated Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma","volume":"92","author":"Pinnix","year":"2015","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ijrobp.2020.08.055","article-title":"Risk of Pneumonitis and Outcomes After Mediastinal Proton Therapy for Relapsed\/Refractory Lymphoma: A PTCOG and PCG Collaboration","volume":"109","author":"Tseng","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.ijrobp.2023.11.026","article-title":"Predicting the Effect of Proton Beam Therapy Technology on Pulmonary Toxicities for Patients with Locally Advanced Lung Cancer Enrolled in the Proton Collaborative Group Prospective Clinical Trial","volume":"119","author":"Valdes","year":"2024","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Tseng, Y.D., Maes, S.M., Kicska, G., Sponsellor, P., Traneus, E., Wong, T., Stewart, R.D., and Saini, J. (2019). Comparative Photon and Proton Dosimetry for Patients with Mediastinal Lymphoma in the Era of Monte Carlo Treatment Planning and Variable Relative Biological Effectiveness. Radiat Oncol., 14.","DOI":"10.1186\/s13014-019-1432-8"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/15\/2736\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:27:57Z","timestamp":1760110077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/15\/2736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":18,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["cancers16152736"],"URL":"https:\/\/doi.org\/10.3390\/cancers16152736","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}