Proton Therapy for Head and Neck Cancer
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The application of proton beam radiation therapy in the treatment of head and neck cancer has grown tremendously in the past few years. Globally, widespread interest in proton beam therapy has led to multiple research efforts regarding its therapeutic value and cost-effectiveness. The current standard of care using modern photon radiation technology has demonstrated excellent treatment outcomes, yet there are some situations where disease control remains suboptimal with the potential for detrimental acute and chronic toxicities. Due to the advantageous physical properties of the proton beam, proton beam therapy may be superior to photon therapy in some patient subsets for both disease control and patient quality of life. As enthusiasm and excitement for proton beam therapy continue to increase, clinical research and widespread adoption will elucidate the true value of proton beam therapy and give a greater understanding of the full risks and benefits of proton therapy in head and neck cancer.
KeywordsHead and neck neoplasms Proton therapy Radiotherapy
Compliance with Ethical Standards
Conflict of Interest
Joseph K. Kim, Jonathan E. Leeman, Nadeem Riaz, Sean McBride, Chiaojung Jillian Tsai, and Nancy Y. Lee declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 4.De Felice F, de Vincentiis M, Luzzi V, Magliulo G, Tombolini M, Ruoppolo G, et al. Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management. Oral Oncol. 2018;77:125–30. https://doi.org/10.1016/j.oraloncology.2017.12.021.CrossRefPubMedGoogle Scholar
- 6.• Romesser PB, Cahlon O, Scher E, Zhou Y, Berry SL, Rybkin A, et al. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Radiother Oncol. 2016;118(2):286–92. https://doi.org/10.1016/j.radonc.2015.12.008. Comparative study of IMRT and PBRT treatment for head and neck cancer. Proton beam radiation demonstrated dosimetric advantages and reductions in acute treatment-related toxicity in comparison to IMRT.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.McDonald MW, Liu Y, Moore MG, Johnstone PA. Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy. Radiat Oncol. 2016;11:32. https://doi.org/10.1186/s13014-016-0600-3.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Patel SH, Wang Z, Wong WW, Murad MH, Buckey CR, Mohammed K, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol. 2014;15(9):1027–38. https://doi.org/10.1016/S1470-2045(14)70268-2.CrossRefPubMedGoogle Scholar
- 9.Holliday EB, Garden AS, Rosenthal DI, Fuller CD, Morrison WH, Gunn GB, et al. Proton therapy reduces treatment-related toxicities for patients with nasopharyngeal cancer: a case-match control study of intensity-modulated proton therapy and intensity-modulated photon therapy. Int J Part Ther. 2015;2(1):19–28. https://doi.org/10.14338/ijpt-15-00011.1.CrossRefGoogle Scholar
- 11.Sio TT, Lin HK, Shi Q, Gunn GB, Cleeland CS, Lee JJ, et al. Intensity modulated proton therapy versus intensity modulated photon radiation therapy for oropharyngeal cancer: first comparative results of patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2016;95(4):1107–14. https://doi.org/10.1016/j.ijrobp.2016.02.044.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Blanchard P, Garden AS, Gunn GB, Rosenthal DI, Morrison WH, Hernandez M, et al. Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer—a case matched analysis. Radiother Oncol. 2016;120(1):48–55. https://doi.org/10.1016/j.radonc.2016.05.022.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Yeh BK, Georges RH, Zhu XR, Palmer MB, Amin MV, Cheung JP, et al. Adaptive replanning is required during intensity modulated proton therapy for head-and-neck cancers. Int J Radiat Oncol Biol Phys. 84(3):S56–S7. https://doi.org/10.1016/j.ijrobp.2012.07.354.
- 15.Slater JD, Yonemoto LT, Mantik DW, Bush DA, Preston W, Grove RI, et al. Proton radiation for treatment of cancer of the oropharynx: early experience at Loma Linda University Medical Center using a concomitant boost technique. Int J Radiat Oncol Biol Phys. 2005;62(2):494–500. https://doi.org/10.1016/j.ijrobp.2004.09.064.CrossRefPubMedGoogle Scholar
- 16.Holliday EB, Kocak-Uzel E, Feng L, Thaker NG, Blanchard P, Rosenthal DI, et al. Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: a case-matched control analysis. Med Dosim. 2016;41(3):189–94. https://doi.org/10.1016/j.meddos.2016.01.002.CrossRefPubMedGoogle Scholar
- 17.Snyers A, Janssens GO, Twickler MB, Hermus AR, Takes RP, Kappelle AC, et al. Malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and morbidity with emphasis on hypothalamic-pituitary deficiency. Int J Radiat Oncol Biol Phys. 2009;73(5):1343–51. https://doi.org/10.1016/j.ijrobp.2008.07.040.CrossRefPubMedGoogle Scholar
- 20.Hoppe BS, Stegman LD, Zelefsky MJ, Rosenzweig KE, Wolden SL, Patel SG, et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting—the MSKCC experience. Int J Radiat Oncol Biol Phys. 2007;67(3):691–702. https://doi.org/10.1016/j.ijrobp.2006.09.023.CrossRefPubMedGoogle Scholar
- 21.Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12(2):127–36. https://doi.org/10.1016/S1470-2045(10)70290-4.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Rosenthal DI, Chambers MS, Fuller CD, Rebueno NC, Garcia J, Kies MS, et al. Beam path toxicities to non-target structures during intensity-modulated radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;72(3):747–55. https://doi.org/10.1016/j.ijrobp.2008.01.012.CrossRefPubMedGoogle Scholar
- 24.Chan A, Adams JA, Weyman E, Parambi R, Goldsmith T, Holman A, et al. A phase II trial of proton radiation therapy with chemotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 84(3):S151–S2. https://doi.org/10.1016/j.ijrobp.2012.07.391.
- 25.Lewis GD, Holliday EB, Kocak-Uzel E, Hernandez M, Garden AS, Rosenthal DI, et al. Intensity-modulated proton therapy for nasopharyngeal carcinoma: decreased radiation dose to normal structures and encouraging clinical outcomes. Head Neck. 2016;38(Suppl 1):E1886–95. https://doi.org/10.1002/hed.24341.CrossRefPubMedGoogle Scholar
- 28.Forastiere AA, Metch B, Schuller DE, Ensley JF, Hutchins LF, Triozzi P, et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus methotrexate in advanced squamous-cell carcinoma of the head and neck: a Southwest Oncology Group study. J Clin Oncol. 1992;10(8):1245–51. https://doi.org/10.1200/JCO.19188.8.131.525.CrossRefPubMedGoogle Scholar
- 29.Salama JK, Vokes EE, Chmura SJ, Milano MT, Kao J, Stenson KM, et al. Long-term outcome of concurrent chemotherapy and reirradiation for recurrent and second primary head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2006;64(2):382–91. https://doi.org/10.1016/j.ijrobp.2005.07.005.CrossRefPubMedGoogle Scholar
- 31.• Romesser PB, Cahlon O, Scher ED, Hug EB, Sine K, DeSelm C, et al. Proton beam reirradiation for recurrent head and neck cancer: multi-institutional report on feasibility and early outcomes. Int J Radiat Oncol Biol Phys. 2016;95(1):386–95. https://doi.org/10.1016/j.ijrobp.2016.02.036. Large, multi-institutional study on re-irradiation of recurrent head and neck cancer using proton beam therapy. Proton radiation therapy was able to demonstrate acceptable acute and late toxicities and tumor control.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.De Crevoisier R, Bourhis J, Domenge C, Wibault P, Koscielny S, Lusinchi A, et al. Full-dose reirradiation for unresectable head and neck carcinoma: experience at the Gustave-Roussy Institute in a series of 169 patients. J Clin Oncol. 1998;16(11):3556–62. https://doi.org/10.1200/JCO.19184.108.40.20656.CrossRefPubMedGoogle Scholar
- 33.van de Water TA, Bijl HP, Schilstra C, Pijls-Johannesma M, Langendijk JA. The potential benefit of radiotherapy with protons in head and neck cancer with respect to normal tissue sparing: a systematic review of literature. Oncologist. 2011;16(3):366–77. https://doi.org/10.1634/theoncologist.2010-0171.CrossRefPubMedPubMedCentralGoogle Scholar
- 35.Ahn PH, Ahn AI, Lee CJ, Shen J, Miller E, Lukaj A, et al. Random positional variation among the skull, mandible, and cervical spine with treatment progression during head-and-neck radiotherapy. Int J Radiat Oncol Biol Phys. 2009;73(2):626–33. https://doi.org/10.1016/j.ijrobp.2008.10.007.CrossRefPubMedGoogle Scholar
- 36.Kraan AC, van de Water S, Teguh DN, Al-Mamgani A, Madden T, Kooy HM, et al. Dose uncertainties in IMPT for oropharyngeal cancer in the presence of anatomical, range, and setup errors. Int J Radiat Oncol Biol Phys. 2013;87(5):888–96. https://doi.org/10.1016/j.ijrobp.2013.09.014.CrossRefPubMedGoogle Scholar
- 37.• Kurz C, Nijhuis R, Reiner M, Ganswindt U, Thieke C, Belka C, et al. Feasibility of automated proton therapy plan adaptation for head and neck tumors using cone beam CT images. Radiat Oncol. 2016;11:64. https://doi.org/10.1186/s13014-016-0641-7. A study aimed to improved quality assurance and treatment adaptation using cone beam CT imaging for proton radiation therapy in head and neck cancer. Automated system was able to reduce overdosing for high-dose and low-dose PTV regions.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Gameiro SR, Malamas AS, Bernstein MB, Tsang KY, Vassantachart A, Sahoo N, et al. Tumor cells surviving exposure to proton or photon radiation share a common immunogenic modulation signature, rendering them more sensitive to T cell-mediated killing. Int J Radiat Oncol Biol Phys. 2016;95(1):120–30. https://doi.org/10.1016/j.ijrobp.2016.02.022.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Palm A, Johansson KA. A review of the impact of photon and proton external beam radiotherapy treatment modalities on the dose distribution in field and out-of-field; implications for the long-term morbidity of cancer survivors. Acta Oncol. 2007;46(4):462–73. https://doi.org/10.1080/02841860701218626.CrossRefPubMedGoogle Scholar