Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives
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 u...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/15/3744 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Pierre Loap |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T09:17:38Z |
| format | Article |
| id | doaj.art-2cc04d117aaf43f8ac5d41e2d20e5ae8 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T09:17:38Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-2cc04d117aaf43f8ac5d41e2d20e5ae82023-11-22T05:27:04ZengMDPI AGCancers2072-66942021-07-011315374410.3390/cancers13153744Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and PerspectivesPierre Loap0Ludovic De Marzi1Alfredo Mirandola2Remi Dendale3Alberto Iannalfi4Viviana Vitolo5Amelia Barcellini6Andrea Riccardo Filippi7Barbara Alicja Jereczek-Fossa8Youlia Kirova9Ester Orlandi10Department of Radiation Oncology, Institut Curie, 75005 Paris, FranceDepartment of Radiation Oncology, Institut Curie, 75005 Paris, FranceRadiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyDepartment of Radiation Oncology, Institut Curie, 75005 Paris, FranceRadiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyRadiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, 27100 Pavia, ItalyDepartment of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, ItalyDepartment of Radiation Oncology, Institut Curie, 75005 Paris, FranceRadiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, ItalyConsolidative 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.https://www.mdpi.com/2072-6694/13/15/3744Hodgkin lymphomaproton therapyNTCP modeltoxicity |
| spellingShingle | 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 Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives Cancers Hodgkin lymphoma proton therapy NTCP model toxicity |
| title | Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives |
| title_full | Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives |
| title_fullStr | Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives |
| title_full_unstemmed | Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives |
| title_short | Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives |
| title_sort | development and implementation of proton therapy for hodgkin lymphoma challenges and perspectives |
| topic | Hodgkin lymphoma proton therapy NTCP model toxicity |
| url | https://www.mdpi.com/2072-6694/13/15/3744 |
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