Life years lost attributable to late effects after radiotherapy for early stage Hodgkin lymphoma: The impact of proton therapy and/or deep inspiration breath hold

Laura Ann Rechner, Maja Vestmø Maraldo, Ivan Richter Vogelius, Xiaorong Ronald Zhu, Bouthaina Shbib Dabaja, Nils Patrik Brodin, Peter Meidahl Petersen, Lena Specht, Marianne Camille Aznar

Research output: Contribution to journalArticle

13 Scopus citations


Background and purpose: Due to the long life expectancy after treatment, the risk of late effects after radiotherapy (RT) is of particular importance for patients with Hodgkin lymphoma (HL). Both deep inspiration breath hold (DIBH) and proton therapy have been shown to reduce the dose to normal tissues for mediastinal HL, but the impact of these techniques in combination is unknown. The purpose of this study was to compare the life years lost (LYL) attributable to late effects after RT for mediastinal HL using intensity modulated radiation therapy (IMRT) in free breathing (FB) and DIBH, and proton therapy in FB and DIBH. Materials and methods: Plans for each technique were created for 22 patients with HL. Doses were extracted and the risk of late effects and LYL were estimated. Results: We found that the use of DIBH, proton therapy, and the combination significantly reduced the LYL compared to IMRT in FB. The lowest LYL was found for proton therapy in DIBH. However, when IMRT in DIBH was compared to proton therapy in FB, no significant difference was found. Conclusions: Patient-specific plan comparisons should be used to select the optimal technique when comparing IMRT in DIBH and proton therapy in FB.

Original languageEnglish (US)
Pages (from-to)41-47
Number of pages7
JournalRadiotherapy and Oncology
Issue number1
Publication statusPublished - Oct 2017



  • Deep inspiration breath hold
  • Late effects
  • Lymphoma
  • Proton therapy
  • Second cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this