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Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence
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Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives

Department of Radiation Oncology, Institut Curie, 75005 Paris, France
Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
Institut Curie, PSL Research University, University Paris Saclay, INSERM LITO, 91400 Orsay, France
Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
Author to whom correspondence should be addressed.
These authors contributed equally to this paper as senior co-last authors.
Academic Editors: Laura Cella, Giuseppe Palma and Andrew Hope
Cancers 2021, 13(15), 3744;
Received: 28 June 2021 / Revised: 23 July 2021 / Accepted: 23 July 2021 / Published: 26 July 2021
Hodgkin lymphoma (HL) is a highly curable disease; proton therapy for mediastinal HL irradiation might theoretically reduce late toxicities compared with classical radiotherapy techniques. However, optimal patient selection for this technique is subject to debate. While implementation at a larger scale of proton therapy for HL may face organizational, political, and societal challenges, new highly effective systematic drugs are being widely evaluated for this disease.
Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with technological advances in treatment techniques currently allows efficient organs-at-risk sparing without altering tumoral control. Recently, proton therapy has been evaluated for mediastinal HL treatment due to its potential to significantly reduce the dose to organs-at-risk, such as cardiac substructures. This is expected to limit late radiation-induced toxicity and possibly, second-neoplasm risk, compared with last-generation intensity-modulated radiation therapy. However, the democratization of this new technique faces multiple issues. Determination of which patient may benefit the most from proton therapy is subject to intense debate. The development of new effective systemic chemotherapy and organizational, societal, and political considerations might represent impediments to the larger-scale implementation of HL proton therapy. Based on the current literature, this critical review aims to discuss current challenges and controversies that may impede the larger-scale implementation of mediastinal HL proton therapy. View Full-Text
Keywords: Hodgkin lymphoma; proton therapy; NTCP model; toxicity Hodgkin lymphoma; proton therapy; NTCP model; toxicity
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MDPI and ACS Style

Loap, P.; De Marzi, L.; Mirandola, A.; Dendale, R.; Iannalfi, A.; Vitolo, V.; Barcellini, A.; Filippi, A.R.; Jereczek-Fossa, B.A.; Kirova, Y.; Orlandi, E. Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives. Cancers 2021, 13, 3744.

AMA Style

Loap P, De Marzi L, Mirandola A, Dendale R, Iannalfi A, Vitolo V, Barcellini A, Filippi AR, Jereczek-Fossa BA, Kirova Y, Orlandi E. Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives. Cancers. 2021; 13(15):3744.

Chicago/Turabian Style

Loap, Pierre, Ludovic De Marzi, Alfredo Mirandola, Remi Dendale, Alberto Iannalfi, Viviana Vitolo, Amelia Barcellini, Andrea Riccardo Filippi, Barbara Alicja Jereczek-Fossa, Youlia Kirova, and Ester Orlandi. 2021. "Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives" Cancers 13, no. 15: 3744.

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