Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.

Department of Oncology Charles University Prague and Motol University Hospital Prague Czech Republic

Department of Oncology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark; and

Department of Radiation Oncology Guy's and St Thomas' Hospital London United Kingdom

Department of Radiation Oncology Institut Curie Paris France

Department of Radiation Oncology Memorial Sloan Kettering Cancer Center New York NY

Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston TX

Department of Radiation Oncology University of Florida Jacksonville FL

Department of Radiation Oncology University of Pennsylvania Philadelphia PA

Department of Radiation Physics The University of Texas MD Anderson Cancer Center Houston TX

Department of Radiation Physics University of Louisiana Baton Rouge LA

Proton Therapy Department Proton Therapy Center Czech Prague Czech Republic

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Blood. 2019 Mar 21;133(12):1384-1385. doi: 10.1182/blood-2019-02-900738. PubMed

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