Abstract
Simple SummaryHodgkin 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.
Highlights
Hodgkin lymphoma (HL) is characterized by a high curative rate, evaluated between80% and 90% [1]
(equal to the sum of RR for IHD and LV failure) > 0.25 or >0.10. Based on these NTCP, EAR, and RR composite score thresholds, the author evaluated the proportion of eligible patients to IMPT based on diverse selection rules, applied on a cohort of 20 patients: (1) if one considered that HL patients are eligible for proton therapy when the three composite scores with VMAT planning were simultaneously greater than the higher thresholds: 5% patients were eligible for IMPT; (2) if HL patients were eligible for proton therapy when the three composite scores with VMAT planning were simultaneously greater than lower thresholds, 20% patients were eligible for IMPT; (3) if HL patients were eligible for proton therapy when composite scores excessed one higher threshold or two lower thresholds, 75% of the patients would eligible for IMPT
Such an approach could probably be developed for HL lymphoma radiotherapy, for which a weighted toxicity score (WTS) could be calculated on competitive treatment plans between VMAT and IMPT, from which an indication for IMPT could be taken
Summary
Hodgkin lymphoma (HL) is characterized by a high curative rate, evaluated between. 80% and 90% [1]. Proton therapy is a promising has been recently reevaluated [9,10]. Proton therapy is a promising techtechnique selected patients who may benefitfrom frommaximal maximalOAR. OAR sparing, sparing, such nique for for selected patients who may benefit such as as young young female patients or patients with cardiovascular comorbidities. Prioritization methods for patient selection are subject to facing multiple issues. Prioritization methods for patient selection are subject to debate, debate, considering the current particle beam therapy facility shortage and the societal and operaconsidering the current particle beam therapy facility shortage and the societal and opertional cost of proton therapy compared with lower-cost classic radiotherapy [11]. The purpose of this review is to identify and discuss controversies and challenges larger implementation of this promising technique in the near future. For the larger implementation of this promising technique in the near future
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