Consolidative Proton Therapy Following High-dose Chemotherapy and Autologous Stem Cell Transplant in an Adolescent with Relapsed Hodgkin Lymphoma.

We present a case of an adolescent male with relapsed Hodgkin lymphoma involving the mediastinum two years following chemotherapy without radiotherapy. The patient was treated with second-line chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant and then presented for evaluation of consolidative involved-field proton therapy (PT). Comparative treatment plans were developed with three-dimensional X-ray radiotherapy (3DXRT) and PT. PT substantially reduced the dose to the lungs, heart, esophagus, and total body compared with 3DXRT, resulting in treatment with PT. PT should reduce the risk of late side effects compared with 3DXRT, including secondary malignancies and cardiovascular disease.