Proton Therapy in Supradiaphragmatic Lymphoma: Predicting Treatment-Related Mortality to Help Optimize Patient Selection

Figures

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  Fig. 1. Predicted 30-year absolute mortality risk (AMR30) for all cardiovascular disease and second cancers. The quantities shown are the average AMR30 for the 80 patients in this study. AMR30 includes background mortality risk (gray bar), absolute excess risk after chemotherapy (black bar), absolute excess risk after photon radiation therapy (yellow bar), and proton beam therapy (blue bar). For each patient, background AMR30 was predicted based on their age and sex. Separate calculations were conducted using population mortality rates from each geographic region. The chemotherapy-related AMR30 was predicted using the excess rate ratio by Van Nimwegen et al.3 The radiation therapy-related AMR30 was predicted using the excess rate ratios, or excess relative risks, per Gy from the studies in Supplemental Table E3, combined with patient-specific radiation doses from photons and proton beam therapy. Further details are provided in Appendix B.

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  Fig. 2. Predicted 30-year absolute mortality risk (AMR30) for all cardiovascular disease and lung cancer as a second primary cancer for male and female patients. Average AMR30 for cardiovascular disease is presented for patients with ≥40% or <40% clinical target volume to the heart longitudinal overlap and for lung cancer for patients with and without axillary disease. The background AMR30 was calculated using standardized U.S. mortality rates. The chemotherapy-related AMR30 was predicted using excess rate ratios by Van Nimwegen et al.3 The radiation therapy-related AMR30 was predicted using the excess relative risks from the studies in Supplemental Table E3, combined with the average radiation dose for each subgroup as shown in Table 2 assigned to every patient. Further details are provided in Appendix B.

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  Fig. 3. Predicted 30-year absolute mortality risks (AMR30) for all cardiovascular disease and lung cancer as a second primary cancer after photon radiation therapy and proton beam therapy for male and female 30-year-old current smokers and male and female 30-year-old never smokers. The background mortality was calculated using U.S. mortality rates. The chemotherapy-related risk was calculated using excess rate ratios by Van Nimwegen et al.3 The radiation-related AMR for cardiovascular disease was calculated assuming the average mean whole heart, left ventricle, and valve doses in patients with ≥40% clinical target volume to the heart overlap. For lung cancer, the average mean lung dose received by patients with axillary disease was used. These doses are shown in Table 2, and further details are provided in Appendices B and C.