Loap Pierre, De Marzi Ludovic, Mirandola Alfredo, Dendale Remi, Iannalfi Alberto, Vitolo Viviana, Barcellini Amelia, Filippi Andrea Riccardo, Jereczek-Fossa Barbara Alicja, Kirova Youlia, Orlandi Ester
Department of Radiation Oncology, Institut Curie, 75005 Paris, France.
Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy.
Cancers (Basel). 2021 Jul 26;13(15):3744. doi: 10.3390/cancers13153744.
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.
早期霍奇金淋巴瘤（HL）的巩固性放射治疗可改善无进展生存期。不幸的是，第一代技术依赖大照射野，与继发性癌症以及心脏和肺部毒性风险增加相关。幸运的是，使用较小的靶体积并结合治疗技术的进步，目前能够在不影响肿瘤控制的情况下有效地保护危险器官。最近，质子治疗因其有可能显著降低对危险器官（如心脏亚结构）的剂量而被评估用于纵隔HL的治疗。与上一代调强放射治疗相比，这有望限制晚期放射诱导的毒性，并可能降低第二肿瘤风险。然而，这项新技术的普及面临多个问题。确定哪些患者可能从质子治疗中获益最大存在激烈争论。新型有效全身化疗的发展以及组织、社会和政治方面的考虑因素可能成为HL质子治疗大规模实施的障碍。基于当前文献，本综述旨在讨论可能阻碍纵隔HL质子治疗大规模实施的当前挑战和争议。
