PBT-IACT for stage III-IVB tongue cancer has an acceptable toxicity profile and showed good treatment results. This protocol should be considered as a treatment option for locally advanced tongue cancer.

ancreatic cancer is the fourth leading cause of cancerrelated mortality in the United States. In 2018, an estimated 55 440 people were diagnosed with pancreatic cancer, and 44 330 people died of it (1). Neoadjuvant chemotherapy and radiation therapy (CRT) is increasingly used to treat potentially resectable pancreatic ductal adenocarcinoma (PDA), especially for borderline resectable disease, as an alternative to surgery. CRT improves the rates of negativemargin resections and possibly treats early micrometastatic disease. However, neoadjuvant CRT is not entirely safe and is sometimes associated with toxicity and disease progression. Consequently, it is important to identify patients likely to respond to CRT to avoid unnecessary drug toxicity while maximizing the chances of tumor regression.In PDA, conventional multiphasic CT is the most widely used imaging modality to evaluate response to therapy by using the Response Evaluation Criteria in Solid Tumors (RECIST). However, it is becoming evident that conventional CT imaging-through assessment of serial tumor size changes-is insufficient for reliable response evaluation after neoadjuvant CRT because of poor correlation with histologic grading of response (2-4). This poor performance can be explained by the abundant fibrous stroma of PDA, which cannot be differentiated from posttherapy fibrous scarring.Obtaining negative pathologic margins (R0) after surgery is an important marker of therapy in PDA. Patients with PDA with R0 have significantly longer survival than patients with positive margins (5,6). Recently, the rate of R0 resection is increasing with the use of neoadjuvant CRT. In a study by Chatterjee et al ( 7), R0 resection was achieved in approximately 90% of patients with PDA

To our knowledge, this is the largest retrospective study of sinonasal squamous cell carcinoma treated with particle therapy alone. The efficacy of PT and CIT indicated that particle therapy can serve an important role in treating this disease.