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

Pierre Loap, Ludovic De Marzi, Alfredo Mirandola, Remi Dendale, Alberto Iannalfi, Viviana Vitolo, Amelia Barcellini, Andrea Riccardo Filippi, Barbara Alicja Jereczek-Fossa, Youlia Kirova, Ester Orlandi

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Issue number15
Publication statusPublished - Jul 26 2021


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