A Phase II Trial of Proton Radiation Therapy With Chemotherapy for Nasopharyngeal Carcinoma

Chan, Anthony T.C.; Adams, Judy; Weyman, Elizabeth A.; Parambi, Ron; Goldsmith, Tessa; Holman, Allison; Truong, M.T.; Busse, Paul M.; DeLaney, Thomas F.

doi:10.1016/j.ijrobp.2012.07.391

Cited by 36 publications

(20 citation statements)

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“…Toxicities included hearing loss (29%) and weight loss (38%). Surprisingly, GT placement was high in this group (48%) [21]. However, these data have not yet been published in manuscript form, and doses to nearby critical structures were not given in the abstract.…”

Section: Discussionmentioning

confidence: 73%

“…However, these data have not yet been published in manuscript form, and doses to nearby critical structures were not given in the abstract. The local control rate at 28 months' follow-up was 100%; the 2-year disease free survival rate was 90% and the overall survival rate, 100% [21]. Temporal lobe necrosis was not specifically mentioned in these publications, so we cannot compare their incidence of this toxicity with the finding that 2 IMRTand 2 IMPT-treated patients developed radionecrosis in our cohort.…”

Section: Discussionmentioning

confidence: 83%

“…There were no significant differences between the groups by any of the matching criteria. Median follow-up was 21…”

Section: Patient and Tumor Characteristicsmentioning

confidence: 99%

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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

Holliday¹,

Garden²,

Rosenthal³

et al. 2015

International Journal of Particle Therapy

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Purpose: The physical properties of proton therapy allow for decreased dose delivery to nontarget structures. The purpose of this study was to determine if this translates into a clinical benefit by comparing acute and chronic morbidity between patients with nasopharyngeal carcinoma who are treated with intensity-modulated proton therapy (IMPT) and those treated with intensity-modulated radiation therapy (IMRT). Materials and Methods: Patients receiving IMPT for nasopharyngeal cancer from 2011-13 were matched in a 2:1 IMPT to IMRT ratio. Matching criteria were, in order, T-stage, N-stage, radiation dose, chemotherapy type, World Health Organization classification, sex, and age. Results: Ten patients treated with IMPT and 20 matched patients treated with IMRT were included. By the end of treatment, 2 IMPT-treated patients (20%) and 13 IMRTtreated patients (65%) required gastrostomy tube (GT) insertion (P ¼ .020). Patients receiving IMPT had significantly lower mean doses to the oral cavity, brainstem, whole brain, and mandible. Increased mean dose to the oral cavity was associated with a higher rate of GT placement (P , .001), but mean dose to the brainstem, whole brain, and mandible was not. Partitioning analysis showed that no patient required GT insertion if the mean oral cavity dose was ,26 Gy, but all patients with a mean oral cavity dose. 41.8 Gy required GT insertion. Treatment type (IMPT versus IMRT), induction chemotherapy (yes versus no), mean oral cavity dose, mean brainstem dose, and mean mandible dose were entered into the multivariable model. Only higher mean oral cavity dose remained significantly associated with higher GT rates on multivariable analysis http://theijpt.org

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 83%

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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

Holliday¹,

Garden²,

Rosenthal³

et al. 2015

International Journal of Particle Therapy

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“…Second, this is the first study to report the planned sequential combination HT and IMPT. In previous studies, PBT was mainly used as a boost technique following or simultaneously with photon therapy, and also showed favorable toxicity and treatment results. Third, the acute toxicity profiles were, more or less, favorable following the HT/IMPT combination, while oncologic outcomes were all excellent and comparable.…”

Section: Discussionmentioning

confidence: 99%

Early clinical outcomes of helical tomotherapy/intensity‐modulated proton therapy combination in nasopharynx cancer

Park

Ahn

et al. 2019

Cancer Science

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This study aimed to evaluate the feasibility of combining helical tomotherapy (HT) and intensity‐modulated proton therapy (IMPT) in treating patients with nasopharynx cancer (NPC). From January 2016 to March 2018, 98 patients received definitive radiation therapy (RT) with concurrent chemotherapy (CCRT). Using simultaneous integrated boost and adaptive re‐plan, 3 different dose levels were prescribed: 68.4 Gy in 30 parts to gross tumor volume (GTV), 60 Gy in 30 parts to high‐risk clinical target volume (CTV), and 36 Gy in 18 parts to low‐risk CTV. In all patients, the initial 18 fractions were delivered by HT, and, after rival plan evaluation on the adaptive re‐plan, the later 12 fractions were delivered either by HT in 63 patients (64.3%, HT only) or IMPT in 35 patients (35.7%, HT/IMPT combination), respectively. Propensity‐score matching was conducted to control differences in patient characteristics. In all patients, grade ≥ 2 mucositis (69.8% vs 45.7%, P = .019) and grade ≥ 2 analgesic usage (54% vs 37.1%, P = .110) were found to be less frequent in HT/IMPT group. In matched patients, grade ≥ 2 mucositis were still less frequent numerically in HT/IMPT group (62.9% vs 45.7%, P = .150). In univariate analysis, stage IV disease and larger GTV volume were associated with increased grade ≥ 2 mucositis. There was no significant factor in multivariate analysis. With the median 14 month follow‐up, locoregional and distant failures occurred in 9 (9.2%) and 12 (12.2%) patients without difference by RT modality. In conclusion, comparable early oncologic outcomes with more favorable acute toxicity profiles were achievable by HT/IMPT combination in treating NPC patients.

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“…Particle therapy offers the potential to reduce doses to OARs in HNC treatment (75,76) and planning studies in NPC have shown improved metrics, with respect to both target coverage and OAR doses (77)(78)(79)(80). However, clinical reports on efficacy and toxicity are limited (79,81,82). In a small retrospective series of 10 patients treated with intensity-modulated proton therapy (IMPT) from MD Anderson, Lewis et al reported no late grade 3 toxicities (79); and grade 1 and 2 xerostomia were reported in 6 and 1 patient/s, respectively.…”

Section: Particle Therapymentioning

confidence: 99%

Quality of Life, Toxicity and Unmet Needs in Nasopharyngeal Cancer Survivors

et al. 2020

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A Phase II Trial of Proton Radiation Therapy With Chemotherapy for Nasopharyngeal Carcinoma

Cited by 36 publications

References 0 publications

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

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

Early clinical outcomes of helical tomotherapy/intensity‐modulated proton therapy combination in nasopharynx cancer

Quality of Life, Toxicity and Unmet Needs in Nasopharyngeal Cancer Survivors

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