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Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives

Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence

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), 3746;
Received: 28 June 2021 / Revised: 22 July 2021 / Accepted: 23 July 2021 / Published: 26 July 2021
Hodgkin lymphoma (HL) is a highly curable disease; in this context, the limitation of late adverse events is of prime importance for the patient. Proton therapy for mediastinal HL irradiation theoretically limits secondary cancer excess risk and should reduce late toxicities compared with classical radiation therapy techniques. However, due to the limited clinical experience, strong evidence is still lacking to support proton therapy in HL management despite excellent tolerance. In addition, randomized controlled trials are probably unrealistic in this context. National and international registries may be useful to strengthen support for HL proton therapy.
Consolidative radiation therapy (RT) is of prime importance for early-stage Hodgkin lymphoma (HL) management since it significantly increases progression-free survival (PFS). Nevertheless, first-generation techniques, relying on large irradiation fields, delivered significant radiation doses to critical organs-at-risk (OARs, such as the heart, to the lung or the breasts) when treating mediastinal HL; consequently, secondary cancers, and cardiac and lung toxicity were substantially increased. Fortunately, HL RT has drastically evolved and, nowadays, state-of-the-art RT techniques efficiently spare critical organs-at-risks without altering local control or overall survival. Recently, proton therapy has been evaluated for mediastinal HL treatment, due to its possibility to significantly reduce integral dose to OARs, which is expected to limit second neoplasm risk and reduce late toxicity. Nevertheless, clinical experience for this recent technique is still limited worldwide. Based on current literature, this critical review aims to examine the current practice of proton therapy for mediastinal HL irradiation. 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.; Mirandola, A.; De Marzi, L.; Dendale, R.; Iannalfi, A.; Vitolo, V.; Barcellini, A.; Filippi, A.R.; Jereczek-Fossa, B.A.; Kirova, Y.; Orlandi, E. Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence. Cancers 2021, 13, 3746.

AMA Style

Loap P, Mirandola A, De Marzi L, Dendale R, Iannalfi A, Vitolo V, Barcellini A, Filippi AR, Jereczek-Fossa BA, Kirova Y, Orlandi E. Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence. Cancers. 2021; 13(15):3746.

Chicago/Turabian Style

Loap, Pierre, Alfredo Mirandola, Ludovic De Marzi, Remi Dendale, Alberto Iannalfi, Viviana Vitolo, Amelia Barcellini, Andrea Riccardo Filippi, Barbara Alicja Jereczek-Fossa, Youlia Kirova, and Ester Orlandi. 2021. "Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence" Cancers 13, no. 15: 3746.

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