Radiation Pneumonitis in Pediatric Hodgkin Lymphoma Patients receiving Radiotherapy to the Chest

Publication date: Available online 4 February 2018
Source:Practical Radiation Oncology
Author(s): Gary D. Lewis, Jennifer E. Agrusa, Bin S. Teh, Maria M. Gramatges, Viral Kothari, Carl E. Allen, Arnold C. Paulino
PurposeThe purpose of this study is to determine the incidence of radiation pneumonitis (RP) in children receiving radiotherapy (RT) for Hodgkin lymphoma (HL).Patients/MethodsA retrospective chart review was conducted of pediatric HL patients who received multiagent chemotherapy followed by RT to any part of the chest. The National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 was used to determine the RP grade. Parameters analyzed included gender, age, bleomycin dose, and RT dosimetric variables such as mean lung dose (MLD), mean individual (right versus left) lung dose or iMLD, V5 to V25 and individual (i) lung V5 to V25.ResultsFrom 2008-2016, 54 children with HL received RT to the chest and had follow-up and dosimetry information. All patients received induction chemotherapy; the most common regimen was ABVE-PC based chemotherapy (n = 48). All received a prescribed dose of 21 Gy in 14 fractions. Median follow-up from completion of RT was 39.5 months. Three of 54 patients (5.6%) or 3 of 108 (2.8%) lungs developed RP; two lungs had Grade 1 while one had Grade 2 RP. RP was seen only in patients with MLD > 12.4 Gy (p = 0.009), V5 > 66% (p = 0.033), V10 >55% (p = 0.015), V15 >45% (p = 0.005) and V20 > 32% (p = 0.007). Likewise, RP was only seen in lungs with iMLD > 13.8 Gy, iV5 > 75% (p =0.02), iV10 > 64% (p = 0.02), iV15 > 47% (< 0.005), and iV20 >34% (p = 0.003).ConclusionsRP in pediatric HL patients is an uncommon complication. MLD, iMLD, V5-V20 and iV5-iV20 correlated with RP.



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