Comparing the oncologic outcomes of proton therapy and intensity-modulated radiation therapy for head and neck squamous cell carcinoma

Chang, Chia-Lun; Lin, Kuan-Chou; Chen, Wan-Ming; Shia, Ben-Chang; Wu, Szu-Yuan

doi:10.1016/j.radonc.2023.109971

Cited by 5 publications

(2 citation statements)

References 47 publications

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“…PT is emerging as an alternative radiation treatment modality with the potential to reduce normal tissue toxicity issues seen in XRT treatments. Several studies comparing intensity-modulated proton therapy (IMPT) to intensity-modulated radiation therapy (IMRT) in HNSCC have demonstrated both dosimetric and potential clinical benefits of IMPT [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Consistent with this, a recent retrospective study involving patients with oropharyngeal carcinoma treated with intensity-modulated proton therapy (IMPT) demonstrated significantly lower levels of acute toxicity compared to those treated with intensity-modulated radiation therapy (IMRT).…”

Section: Discussionmentioning

confidence: 99%

Radiobiology of Proton Therapy in Human Papillomavirus-Negative and Human Papillomavirus-Positive Head and Neck Cancer Cells

Dok,

Vanderwaeren,

Verstrepen

et al. 2024

Cancers

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Photon-based radiotherapy (XRT) is one of the most frequently used treatment modalities for HPV-negative and HPV-positive locally advanced head and neck squamous cell carcinoma (HNSCC). However, locoregional recurrences and normal RT-associated toxicity remain major problems for these patients. Proton therapy (PT), with its dosimetric advantages, can present a solution to the normal toxicity problem. However, issues concerning physical delivery and the lack of insights into the underlying biology of PT hamper the full exploitation of PT. Here, we assessed the radiobiological processes involved in PT in HPV-negative and HPV-positive HNSCC cells. We show that PT and XRT activate the DNA damage-repair and stress response in both HPV-negative and HPV-positive cells to a similar extent. The activation of these major radiobiological mechanisms resulted in equal levels of clonogenic survival and mitotic cell death. Altogether, PT resulted in similar biological effectiveness when compared to XRT. These results emphasize the importance of dosimetric parameters when exploiting the potential of increased clinical effectiveness and reduced normal tissue toxicity in PT treatment.

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Section: Discussionmentioning

confidence: 99%

Radiobiology of Proton Therapy in Human Papillomavirus-Negative and Human Papillomavirus-Positive Head and Neck Cancer Cells

Dok,

Vanderwaeren,

Verstrepen

et al. 2024

Cancers

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“…Indeed, while PT exhibits superior dose distribution characteristics compared to photon RT, there is still a need for quantifiable clinical evidence to establish its clear advantage; only a thorough assessment of proton effectiveness may warrant a reconsideration of government health policies and insurance coverage. To date, most of the available evidence comes from retrospective studies, such as the largest and most recent cohort study by Chang et al which is the first to compare the oncologic outcomes of PT and IMRT for patients with HNSCC [ 84 ]. Using a propensity score matching approach, PT was shown to be associated with improved overall survival and cancer-specific survival and reduced locoregional recurrence rates, but randomized clinical trials and prospective cohort studies are mandatory to confirm these findings.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

Current Status and Future Directions of Proton Therapy for Head and Neck Carcinoma

Lillo,

Mirandola,

Vai

et al. 2024

Cancers

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The growing interest in proton therapy (PT) in recent decades is justified by the evidence that protons dose distribution allows maximal dose release at the tumor depth followed by sharp distal dose fall-off. But, in the holistic management of head and neck cancer (HNC), limiting the potential of PT to a mere dosimetric advantage appears reductive. Indeed, the precise targeting of PT may help evaluate the effectiveness of de-escalation strategies, especially for patients with human papillomavirus associated-oropharyngeal cancer (OPC) and nasopharyngeal cancer (NPC). Furthermore, PT could have potentially greater immunogenic effects than conventional photon therapy, possibly enhancing both the radiotherapy (RT) capability to activate anti-tumor immune response and the effectiveness of immunotherapy drugs. Based on these premises, the aim of the present paper is to conduct a narrative review reporting the safety and efficacy of PT compared to photon RT focusing on NPC and OPC. We also provide a snapshot of ongoing clinical trials comparing PT with photon RT for these two clinical scenarios. Finally, we discuss new insights that may further develop clinical research on PT for HNC.

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Efficacy and safety of proton therapy versus intensity‐modulated radiation therapy in the treatment of head and neck tumors: A systematic review and meta‐analysis

Vasudevan,

Deeb,

Katta

et al. 2024

Head & Neck

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To comprehensively evaluate the therapeutic efficacy and safety when utilizing proton therapy (PT) versus intensity‐modulated radiation therapy (IMRT) in head and neck cancer patients. Pubmed, ScienceDirect, Embase, Scopus, and Web of Science were systematically searched for studies on comparative PT and IMRT outcomes. We performed a random effect model meta‐analysis to estimate the hazard ratio (HR) and odds ratio (OR) for efficacy and safety outcome variables between PT and IMRT. From 641 identified articles, 11 studies met the inclusion criteria, comprising 3087 patients (606 treated with PT and 2481 with IMRT). On toxicity analysis, PT is associated with decreased acute grade 1 nausea (OR = 0.34, 95% CI: 0.13–0.84, p = 0.02) compared to IMRT. In grade 2 toxicity, PT showed significant advantages over IMRT in mucositis (OR = 0.44, p < 0.0001), dysgeusia (OR = 0.35, p = 0.02), dysphagia (OR = 0.36, p < 0.0001), fatigue (OR = 0.29, p = 0.001), pain (OR = 0.34, p = 0.01), and weight loss (OR = 0.54, p = 0.02). Proton therapy also exhibited increased safety in grade 3 dysphagia incidence (OR = 0.44, p < 0.0001) compared to IMRT. PT demonstrated improved overall survival (OS) compared to IMRT across multiple time points: 1‐year OS (HR = 0.43, p = 0.02), 2‐year OS (HR = 0.44, p < 0.0001), and 5‐year OS (HR = 0.78, p = 0.004). In terms of disease‐free survival (DFS), PT also showed improved outcomes at 2‐year DFS (HR = 0.65, p = 0.03) and 5‐year DFS (HR = 0.81, p = 0.03). Proton therapy demonstrated superior overall survival (OS), disease‐free survival (DFS), and better local control rate (LCR) compared to IMRT. The data also showed better safety outcomes in PT patients, particularly when involving grade 2 acute toxicity events.

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Comparing the oncologic outcomes of proton therapy and intensity-modulated radiation therapy for head and neck squamous cell carcinoma

Cited by 5 publications

References 47 publications

Radiobiology of Proton Therapy in Human Papillomavirus-Negative and Human Papillomavirus-Positive Head and Neck Cancer Cells

Radiobiology of Proton Therapy in Human Papillomavirus-Negative and Human Papillomavirus-Positive Head and Neck Cancer Cells

Current Status and Future Directions of Proton Therapy for Head and Neck Carcinoma

Efficacy and safety of proton therapy versus intensity‐modulated radiation therapy in the treatment of head and neck tumors: A systematic review and meta‐analysis

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