Proton Therapy for Head and Neck Cancer: A 12-Year, Single-Institution Experience

Abstract

Purpose To characterize our experience and the disease control and toxicity of proton therapy (PT) for patients with head and neck cancer (HNC). Patients and Methods Clinical outcomes for patients with HNC treated with PT at our institution were prospectively collected in 2 institutional review board–approved prospective studies. Descriptive statistics were used to summarize patient characteristics and outcomes. Overall survival, local-regional control, and disease-free survival were estimated by the Kaplan-Meier method. Treatment-related toxicities were recorded according to the Common Terminology Criteria for Adverse Events (version 4.03) scale. Results The cohort consisted of 573 patients treated from February 2006 to June 2018. Median patient age was 61 years. Oropharynx (33.3%; n = 191), paranasal sinus (11%; n = 63), and periorbital tissues (11%; n = 62) were the most common primary sites. Patients with T3/T4 or recurrent disease comprised 46% (n = 262) of the cohort. The intent of PT was definitive in 53% (n = 303), postoperative in 37% (n = 211), and reirradiation in 10% (n = 59). Median dose was 66 Gy (radiobiological equivalent). Regarding systemic therapy, 43% had received concurrent (n = 244), 3% induction (n = 19), and 15% (n = 86) had both. At a median follow-up of 2.4 years, 88 patients (15%) had died and 127 (22%) developed disease recurrence. The overall survival, local-regional control, and disease-free survival at 2 and 5 years were, respectively, 87% and 75%, 87% and 78%, and 74% and 63%. Maximum toxicity (acute or late) was grade 3 in 293 patients (51%), grade 2 in 234 patients (41%), and grade 1 in 31 patients (5%). There were 381 acute grade 3 and 190 late grade 3 unique toxicities across 212 (37%) and 150 (26%) patients, respectively. There were 3 late-grade 4 events across 2 patients (0.3%), 2 (0.3%) acute-grade 5, and no (0%) late-grade 5 events. Conclusions The overall results from this prospective study of our initial decade of experience with PT for HNC show favorable disease control and toxicity outcomes in a multidisease-site cohort and provide a reference benchmark for future comparison and study.

Proton therapy & oral mucositis in oral&oropharyngeal cancers: outcomes, dosimetric&NTCP benefit

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Tongue Displacement Device in Decreasing the Radiation Dose to Tongue and Preventing Proton Beam Overshoot in Proton Therapy for Unilateral Head and Neck Cancer

“…IMPT plans were generated using one or two single-field optimization beams [4,25] based on line scanning with a range shifter (4 cm water equivalent thickness) for both the 1). The Sumitomo Proton machine (Sumitomo Proton Therapy System, Sumitomo Heavy Industries, Ltd.) model was used to create the IMPT plans.…”

Re-Irradiation for Recurrent Head and Neck Cancer: Freedom from Cancer Recurrence Rate

“…Palliative chemotherapy with or without targeted therapy or immunotherapy resulted in non-curable short-term responses with relatively short survival [2][3][4][5]. Whenever feasible (based on available resources, expertise, patient, and tumor characteristics at time of LRR), the use of potentially curative locoregional treatment such as salvage surgery and adequate dose re-irradiation (rRT)+/− concurrent chemotherapy is encouraged [6][7][8][9][10].…”