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© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Simple Summary

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.

Abstract

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.

Details

Title
Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives
Author
Loap, Pierre 1 ; De Marzi, Ludovic 2   VIAFID ORCID Logo  ; Mirandola, Alfredo 3   VIAFID ORCID Logo  ; Dendale, Remi 4 ; Iannalfi, Alberto 3 ; Vitolo, Viviana 3 ; Barcellini, Amelia 3   VIAFID ORCID Logo  ; Filippi, Andrea Riccardo 5   VIAFID ORCID Logo  ; Jereczek-Fossa, Barbara Alicja 6 ; Kirova, Youlia 4 ; Orlandi, Ester 3 

 Department of Radiation Oncology, Institut Curie, 75005 Paris, France; [email protected] (L.D.M.); [email protected] (R.D.); [email protected] (Y.K.); Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; [email protected] (A.M.); [email protected] (A.I.); [email protected] (V.V.); [email protected] (A.B.); [email protected] (E.O.) 
 Department of Radiation Oncology, Institut Curie, 75005 Paris, France; [email protected] (L.D.M.); [email protected] (R.D.); [email protected] (Y.K.); Institut Curie, PSL Research University, University Paris Saclay, INSERM LITO, 91400 Orsay, France 
 Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; [email protected] (A.M.); [email protected] (A.I.); [email protected] (V.V.); [email protected] (A.B.); [email protected] (E.O.) 
 Department of Radiation Oncology, Institut Curie, 75005 Paris, France; [email protected] (L.D.M.); [email protected] (R.D.); [email protected] (Y.K.) 
 Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, 27100 Pavia, Italy; [email protected] 
 Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; [email protected]; Division of Radiotherapy, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy 
First page
3744
Publication year
2021
Publication date
2021
Publisher
MDPI AG
e-ISSN
20726694
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2558717510
Copyright
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.