Proton beam radiation therapy treatment for head and neck cancer

Abstract

Proton beam therapy has gained popularity over recent years. This is likely due to improved affordability; that is, lower cost, and increasing reports on excellent patient‐reported outcomes. Protons’ physical properties provide dosimetric advantages over photon therapy due to the unique ability to have little‐to‐no “exit” dose, potentially translating to reduced toxicities and improved patient quality of life. The increased delivery of proton beam therapy to treat numerous head and neck cancers, including oropharynx, nasopharynx, sinonasal, in the re‐irradiation setting, and unilateral malignancies, has led to more studies elucidating the clinical risks and benefits. In this review, we aim to summarize the recent literature on proton beam therapy utilization in head and neck cancer. In addition, we discuss the process of treatment and planning, clinical treatment toxicities and outcomes, limitations, and future directions.

Dose–volume constraints for head‐and‐neck cancer in carbon ion radiotherapy: A literature review

“… 43 Also, it is sensitive to setup errors and anatomical variations due to tumor response and changes in the weight of the patient. 44 …”

Proton Therapy for Squamous Cell Carcinoma of the Head and Neck: Early Clinical Experience and Current Challenges

“…In the re-irradiation setting, PT appears to have a relatively safe toxicity profile, with acceptable outcomes compared to historical IMRT outcomes [ 17 , 54 ]. In the largest multi-institutional study of 92 patients re-irradiated with PT for recurrent head and neck cancer by Romesser et al, 1 year locoregional failure was 25.1%.…”

“…Encouraged by the early clinical experience, several randomized trials have been launched to investigate the effectiveness of PT in terms of oncologic outcomes and toxicity reduction [ 17 ]. Some series limit inclusion criteria to one HNC subsite, e.g., NCT01893307 and NCT04609280 including locally-advanced OPSCC, and NCT04528394, NCT00592501 and NCT02135042 including only NPSCC [ 115 ].…”

“…Since the observed differences may be overestimated, clinical evaluation is necessary. Clinical evidence for PT in patients with HNSCC is limited, and level I evidence for PT is lacking [ 17 ]. Therefore, it has been a challenge to identify patients that would benefit the most from PT.…”

Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group

“…Proton therapy has been proposed as a potential radiotherapy modality to improve older head and neck cancer patients’ tolerance to treatment due to its normal organ-sparing property [ 96 ]. Indeed, the limited penetration of protons associated with its Bragg peak effect allows proton therapy to deliver a high radiation dose to the tumor and for the sparing of normal organs [ 97 ]. However, the cost and limited availability of proton centers make it impractical for the general cancer population [ 98 ].…”