Proton therapy in mediastinal Hodgkin lymphoma: moving from dosimetric prediction to clinical evidence

Combined modality therapy with chemotherapy followed by consolidation radiotherapy is now considered the standard of care in early-stage Hodgkin lymphoma (HL); in advanced stage disease with bulky sites, radiotherapy may also be used to locally consolidate response after more intensive chemotherapy [1]. As most early-stage HL patients achieve durable complete remission and become long-term survivors, it is important to reduce the risk of treatment-induced late effects [2]. This is especially relevant for patients with mediastinal involvement as their disease is in close proximity to critical healthy tissues (heart, lungs, breasts). The effort to reduce treatment-related toxicity—mainly cardiovascular disease and secondary malignancies—is the main driver behind the recent improvements in the radiation therapy (RT) delivery for patients with HL.

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