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Purpose: Protontherapy for mediastinal Hodgkin lymphoma reduces cardiac, lung and breast exposure, which may limit radiation-induced adverse events. While this technique is already widely implemented in the United-States, clinical experience is still limited in France. This study analyses the practice of mediastinal Hodgkin lymphoma protontherapy at the Institut Curie to implement this technique at a larger scale., Materials and Methods: Data from all mediastinal Hodgkin lymphoma patients from the hematology department of the Institut Curie who were subsequently evaluated at the Protontherapy Center of Orsay (CPO) of Institut Curie for adjuvant protontherapy were retrieved. We analyzed why these patients were ultimately treated with protontherapy or not., Results: Between January 2018 and January 2021, twenty mediastinal Hodgkin lymphoma patients from the hematology department of the Institut Curie have been screened for protontherapy at the CPO. Four of them (20%) were ultimately treated with proton beams. Treatment was well tolerated without grade 3-4 adverse events. With a median follow-up of two years, none of these patients relapsed. The others sixteen patients were not treated with protontherapy due to multiple reasons including: lack of treatment room disponibility, accessibility difficulties, psychiatric disorder, and anatomic or dosimetric considerations., Conclusion: Despite notable dosimetric superiority over photon radiotherapy and excellent clinical tolerance, lack of availability of protontherapy facilities limit implementation of mediastinal Hodgkin lymphoma protontherapy. Additionally, strict selection criteria must be defined., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Purpose: Breast protontherapy efficiently limits cardiac, lung and contralateral breast exposure, which may clinically translate into better late tolerance profile compared with classic photon techniques. While breast protontherapy is already implemented in the United States and in some European countries, clinical experience of breast cancer protontherapy is currently limited in France. The aim of this study is to evaluate the clinical practice of breast cancer protontherapy at the Institut Curie in order to implement this technique at a larger scale., Materials and Methods: Data from all breast cancer patients that have been addressed to the protontherapy centre of Orsay (CPO, Institut Curie) for adjuvant breast protontherapy were retrieved. We analysed why these patients were ultimately treated with protontherapy or not., Results: Between November 2019 and November 2020, eleven breast cancer patients have been evaluated for adjuvant protontherapy at the CPO. Two of them were ultimately treated with proton beams; adjuvant breast protontherapy therapy was well tolerated. The nine other patients were not treated with protontherapy due to lack of availability of protontherapy treatment rooms in acceptable time limits, at the time of patient evaluation., Conclusion: Despite dosimetric advantages and excellent clinical tolerance, lack of availability of protontherapy machines currently limits wider implementation of breast protontherapy., (Copyright © 2021 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.)

Proton beam therapy is indicated as a treatment for some rare tumours and paediatric tumours because the technique allows a good local control with minimal toxicity; the growing number of centres that use proton beam therapy is associated with an increase of dosimetric and clinical data for other malignant tumours as well. This paper reviews potential indications of proton beam therapy. A systematic review on Medline was performed with the following keywords proton beam therapy, cancer, heavy particle, charged particle. No phase III trial has been published using proton beam therapy in comparison with the best photon therapy, but numerous retrospective and dosimetric studies have revealed an advantage of proton beam therapy compared to photons, above all in tumours next to parallel organs at risk (thoracic and abdominal tumours). This could be accompanied with a better safety profile and/or a better tumoural control; numerous phase 0, I, II, III and IV studies are ongoing to examine these hypotheses in more common cancers. Use of proton beam therapy is growing for common cancers within clinical trials but some indications could be applied sooner since in silico analysis showed major advantages with this technique., (Copyright © 2015. Published by Elsevier SAS.)