Skip to main content

Advertisement

SpringerLink
Log in

Proton Therapy for Head and Neck Cancer

  • Head and Neck Cancer (L Licitra, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Thariat J, Bruchon Y, Bonnetain F, Barillot I, Truc G, Peignaux K, et al. Conservative treatment of early glottic carcinomas with exclusive radiotherapy. Cancer Radiother. 2004;8(5):288–96. https://doi.org/10.1016/j.canrad.2004.08.003.

    Article  PubMed  CAS  Google Scholar 

  2. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091–8. https://doi.org/10.1056/NEJMoa031317.

    Article  PubMed  CAS  Google Scholar 

  3. Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tan PF, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010;363(1):24–35. https://doi.org/10.1056/NEJMoa0912217.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  5. Leeman JE, Romesser PB, Zhou Y, McBride S, Riaz N, Sherman E, et al. Proton therapy for head and neck cancer: expanding the therapeutic window. Lancet Oncol. 2017;18(5):e254–e65. https://doi.org/10.1016/S1470-2045(17)30179-1.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  CAS  Google 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.

    Article  PubMed  CAS  Google 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.

    Article  Google Scholar 

  10. Zhang W, Zhang X, Yang P, Blanchard P, Garden AS, Gunn B, et al. Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer. Radiother Oncol. 2017;123(3):401–5. https://doi.org/10.1016/j.radonc.2017.05.006.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google 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.

  14. Ahn PH, Lukens JN, Teo BK, Kirk M, Lin A. The use of proton therapy in the treatment of head and neck cancers. Cancer J. 2014;20(6):421–6. https://doi.org/10.1097/PPO.0000000000000077.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  18. Mock U, Georg D, Bogner J, Auberger T, Potter R. Treatment planning comparison of conventional, 3D conformal, and intensity-modulated photon (IMRT) and proton therapy for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys. 2004;58(1):147–54.

    Article  PubMed  Google Scholar 

  19. Lomax AJ, Goitein M, Adams J. Intensity modulation in radiotherapy: photons versus protons in the paranasal sinus. Radiother Oncol. 2003;66(1):11–8.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kuang WL, Zhou Q, Shen LF. Outcomes and prognostic factors of conformal radiotherapy versus intensity-modulated radiotherapy for nasopharyngeal carcinoma. Clin Transl Oncol. 2012;14(10):783–90. https://doi.org/10.1007/s12094-012-0864-5.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  26. Chan AW, Liebsch LJ, Deschler DG, Adams JA, Vrishali LV, McIntyre JF, et al. Proton radiotherapy for T4 nasopharyngeal carcinoma. J Clin Oncol. 2004;22(14_suppl):5574. https://doi.org/10.1200/jco.2004.22.90140.5574.

    Article  Google Scholar 

  27. Phan J, Sio TT, Nguyen TP, Takiar V, Gunn GB, Garden AS, et al. Reirradiation of head and neck cancers with proton therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys. 2016;96(1):30–41. https://doi.org/10.1016/j.ijrobp.2016.03.053.

    Article  PubMed  Google 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.1992.10.8.1245.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google Scholar 

  30. Takiar V, Garden AS, Ma D, Morrison WH, Edson M, Zafereo ME, et al. Reirradiation of head and neck cancers with intensity modulated radiation therapy: outcomes and analyses. Int J Radiat Oncol Biol Phys. 2016;95(4):1117–31. https://doi.org/10.1016/j.ijrobp.2016.03.015.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.1998.16.11.3556.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Cozzi L, Fogliata A, Lomax A, Bolsi A. A treatment planning comparison of 3D conformal therapy, intensity modulated photon therapy and proton therapy for treatment of advanced head and neck tumours. Radiother Oncol. 2001;61(3):287–97.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Ramaekers BL, Grutters JP, Pijls-Johannesma M, Lambin P, Joore MA, Langendijk JA. Protons in head-and-neck cancer: bridging the gap of evidence. Int J Radiat Oncol Biol Phys. 2013;85(5):1282–8. https://doi.org/10.1016/j.ijrobp.2012.11.006.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013;87(1):46–52. https://doi.org/10.1016/j.ijrobp.2013.04.030.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google Scholar 

  42. Dagan R, Bryant C, Li Z, Yeung D, Justice J, Dzieglewiski P, et al. Outcomes of sinonasal cancer treated with proton therapy. Int J Radiat Oncol Biol Phys. 2016;95(1):377–85. https://doi.org/10.1016/j.ijrobp.2016.02.019.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1250 1st Avenue, New York, NY, 10065, USA

    Joseph K. Kim BS, Jonathan E. Leeman MD, Nadeem Riaz MD, Sean McBride MD, MPH, Chiaojung Jillian Tsai MD, PhD, MS & Nancy Y. Lee MD

Authors
  1. Joseph K. Kim BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan E. Leeman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nadeem Riaz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sean McBride MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chiaojung Jillian Tsai MD, PhD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nancy Y. Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nancy Y. Lee MD.

Ethics declarations

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.

Additional information

This article is part of the Topical Collection on Head and Neck Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.K., Leeman, J.E., Riaz, N. et al. Proton Therapy for Head and Neck Cancer. Curr. Treat. Options in Oncol. 19, 28 (2018). https://doi.org/10.1007/s11864-018-0546-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-018-0546-9

Keywords

Search

Navigation