Improving the therapeutic ratio in Hodgkin lymphoma through the use of proton therapy.

Although definitive radiotherapy (RT) and consolidative RT have been found to cure patients with Hodgkin lymphoma (HL)[1] and to improve event-free and overall survival in patients with early-stage HL treated with chemotherapy,[2] RT in HL is also responsible for some of the late toxicities that can occur 10 to 40 years following treatment. These toxicities include secondary malignancies, cardiovascular disease, hypothyroidism, cerebrovascular accidents, and muscle atrophy. Indeed, Oeffinger et al have reported a 40% cumulative incidence of grade 3 to 5 chronic toxicity attributed to chemotherapy and RT among HL survivors 25 years following treatment.[3]