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Particle therapy for mucosal melanoma of the head and neck

A single-institution retrospective comparison of proton and carbon ion therapy

Partikeltherapie beim Schleimhautmelanom der Kopf-Hals-Region

Monozentrischer retrospektiver Vergleich von Protonen- und Kohlenstoffionentherapie

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Abstract

Purpose

To retrospectively analyze treatment outcomes after particle therapy using protons or carbon ions for mucosal melanoma of the head and neck (HNMM) at the Hyogo Ion Beam Medical Center, as well as to compare proton therapy (PT) and carbon ion therapy (CIT).

Patients and methods

Data from 62 HNMM patients without metastasis, treated with PT or CIT between October 2003 and April 2011 were analyzed. Median patient age was 70.5 years (range 33–89 years). Of the total patients, 33 (53 %) had received PT and 29 (47 %) had undergone CIT. Protocols for 65 or 70.2 GyE in 26 fractions were used for both ion types.

Results

Median follow-up was 18.0 months (range 5.2–82.7 months). The 1-/2-year overall survival (OS) and local control (LC) rates were 93 %/61 % and 93 %/78 % for all patients, 91 %/44 % and 92 %/71 % for the PT patients and 96 %/62 % and 95 %/59 % for the CIT patients, respectively. No significant differences were observed between PT and CIT. Local recurrence was observed in 8 patients (PT: 5, CIT: 3) and 29 (PT: 18, CIT: 11) experienced distant metastases. Acute reactions were acceptable and all patients completed the planned radiotherapy. Regarding late toxicity, grade 3 or greater events were observed in 5 patients (PT: 3, CIT: 2), but no significant difference was observed between PT and CIT.

Conclusion

Our single-institution retrospective analysis demonstrated that particle therapy for HNMM achieved good LC, but OS was unsatisfactory. There were no significant differences between PT and CIT in terms of either efficacy or toxicity.

Zusammenfassung

Ziel

Retrospektive Analyse der Behandlungsergebnisse nach Partikeltherapie mit Protonen- oder Kohlenstoffionen beim Schleimhautmelanom der Kopf-Hals-Region (SMKH) am Hyogo Ion Beam Medical Center im Hinblick auf den Vergleich von Protonen- (PT) und Kohlenstoffionentherapie (CIT).

Patienten und Methodik

Analysiert wurden 62 Patienten mit SMKH und ohne Metastasen, die zwischen Oktober 2003 und April 2011 mit PT oder CIT behandelt worden waren. Das mediane Alter der Patienten betrug 70,5 Jahre (Spannweite 33–89 Jahre). Insgesamt 33 Patienten (53 %) wurden mit PT behandelt, 29 (47 %) mit CIT. Bei beiden Ionenarten wurden die Protokolle für 65 oder 70,2 GyE in 26 Fraktionen angewendet.

Ergebnisse

Die mediane Nachbeobachtungszeit betrug 18 Monate (Spannweite 5,2–82,7 Monate). Die 1- und 2-Jahres-Raten für Gesamtüberleben und lokale Kontrolle betrugen für alle Patienten zusammen 93 %/61 % bzw. 93 %/78 % sowie 91 %/44 % bzw. 92 %/71 % bei den PT-Patienten und 96 %/62 % bzw. 95 %/59 % bei den CIT-Patienten. Zwischen PT und CIT wurden keine signifikanten Unterschiede beobachtet. Bei 8 Patienten (PT: 5, CIT: 3) traten lokale Rezidive auf und bei 29 Patienten (PT: 18, CIT: 11) wurden Fernmetastasen entdeckt. Die akuten Reaktionen waren akzeptabel und alle Patienten schlossen die Strahlentherapie planmäßig ab. Was die Langzeittoxizität angeht, wurden Ereignisse vom Schweregrad 3 oder höher bei 5 Patienten beobachtet (PT: 3, CIT: 2), wobei kein signifikanter Unterschied zwischen PT und CIT festzustellen war.

Schlussfolgerung

Unsere monozentrische retrospektive Analyse belegt gute Erfolge der SMKH-Partikeltherapie bezüglich der lokalen Beherrschung, jedoch unbefriedigende Ergebnisse im Hinblick auf das Gesamtüberleben. Weder bei der Wirksamkeit noch bei der Toxizität bestanden signifikante Unterschiede zwischen PT und CIT.

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Notes

  1. The particle beam dose is reported in Gray equivalents (GyE), which is the physical dose multiplied by the relative biological effectiveness (RBE) of the protons or carbon ions. Biological effects of both PT and CIT at HIBMC were evaluated in vitro and in vivo and the RBE values for proton and carbon ion irradiation were determined to be 2–3.7 (depending on the depth in the spread-out Bragg peaks) and 1.1, respectively [5].

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Compliance with ethical guidelines

Conflict of interest. Y. Demizu, O. Fujii, K. Terashima, M. Mima, N. Hashimoto, Y. Niwa, T. Akagi, T. Daimon, M. Murakami and N. Fuwa state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Consent was obtained from all patients identifiable from images or other information within the manuscript. In the case of underage patients, consent was obtained from a parent or legal guardian.

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Authors and Affiliations

  1. Department of Radiology, Hyogo Ion Beam Medical Center, 1–2–1 Kouto, Shingu-cho, 679–5165, Tatsuno, Hyogo, Japan

    Y. Demizu M.D., Ph.D., O. Fujii, K. Terashima, M. Mima, N. Hashimoto & N. Fuwa

  2. Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Y. Niwa

  3. Department of Radiation Physics, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan

    T. Akagi

  4. Department of Biostatistics, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    T. Daimon

  5. Center for Radiation Oncology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan

    M. Murakami

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  1. Y. Demizu M.D., Ph.D.
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  2. O. Fujii
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  3. K. Terashima
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  4. M. Mima
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  5. N. Hashimoto
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  6. Y. Niwa
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  7. T. Akagi
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  8. T. Daimon
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  9. M. Murakami
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  10. N. Fuwa
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Correspondence to Y. Demizu M.D., Ph.D..

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Demizu, Y., Fujii, O., Terashima, K. et al. Particle therapy for mucosal melanoma of the head and neck. Strahlenther Onkol 190, 186–191 (2014). https://doi.org/10.1007/s00066-013-0489-9

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  • DOI: https://doi.org/10.1007/s00066-013-0489-9

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