Quality of Life of Postoperative Photon versus Proton Radiation Therapy for Oropharynx Cancer

Sharma, Sonam; Zhou, Olivia; Thompson, Reid F.; Gabriel, Peter; Chalian, Ara A.; Rassekh, Christopher H.; Weinstein, Gregory S.; O’Malley, Bert W.; Aggarwal, Charu; Bauml, Joshua; Cohen, Roger B.; Lukens, John N.; Swisher‐McClure, Samuel; Ghiam, Alireza Fotouhi; Ahn, Peter H.; Lin, Alexander

doi:10.14338/ijpt-18-00032.1

Cited by 34 publications

(37 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2005, Slater and colleagues [17] reported the first clinical use of proton therapy in the treatment of oropharyngeal cancer. More recently, the University of Pennsylvania [18], Memorial Sloan Kettering [19], and MD Anderson Cancer Center [20] reported on their experiences with IMPT. The MD Anderson Cancer Center also performed a nonrandomized case-matched analysis with IMRT in a more contemporary setting [21,22].…”

Section: Introductionmentioning

confidence: 99%

Proton Therapy for Locally Advanced Oropharyngeal Cancer: Initial Clinical Experience at the University of Washington

Aljabab

Liu

Wong

et al. 2019

International Journal of Particle Therapy

View full text Add to dashboard Cite

Purpose: Proton therapy can potentially improve the therapeutic ratio over conventional radiation therapy for oropharyngeal squamous cell cancer (OPSCC) by decreasing acute and late toxicity. We report our early clinical experience with intensity-modulated proton therapy (IMPT). Materials and Methods: We retrospectively reviewed patients with OPSCC treated with IMPT at our center. Endpoints include local regional control (LRC), progression-free survival (PFS), overall survival (OS), tumor response, and toxicity outcomes. Toxicity was graded as per the Common Terminology Criteria for Adverse Events v4.03. Descriptive statistics and Kaplan-Meier method were used. Results: We treated 46 patients from March 2015 to August 2017. Median age was 58 years, 93.5% were male, 67% were nonsmokers, 98% had stage III-IVB disease per the 7th edition of the AJCC [American Joint Committee on Cancer] Cancer Staging Manual, and 89% were p16 positive. Twenty-eight patients received definitive IMPT to total dose of 70 to 74.4 Gy(RBE), and 18 patients received postoperative IMPT to 60 to 66 Gy(RBE) following transoral robotic surgery (TORS). Sixty-four percent of patients received concurrent systemic therapy. There were no treatment interruptions or observed acute grade 4 or 5 toxicities. Eighteen patients had percutaneous endoscopic gastrostomy (PEG) tube placement; the majority (14) were placed prophylactically. The most common grade 3 acute toxicities were dermatitis (76%) and mucositis (72%). The most common late toxicity was grade 2 xerostomia (30%). At a median follow-up time of 19.2 months (interquartile range [IQR], 11.2-28.4), primary complete response was 100% and nodal complete response was 92%. One patient required a salvage neck dissection owing to an incomplete response at 4 months. There were no recorded local regional or marginal recurrences, PFS was 93.5%, and OS was 95.7%. Conclusion: Our early results for IMPT in OPSCC are promising with no local regional or marginal recurrences and a favorable toxicity profile. Our data add to a body of evidence that supports the clinical use of IMPT. Randomized comparative trials are encouraged.

show abstract

Section: Introductionmentioning

confidence: 99%

Proton Therapy for Locally Advanced Oropharyngeal Cancer: Initial Clinical Experience at the University of Washington

Aljabab

Liu

Wong

et al. 2019

International Journal of Particle Therapy

View full text Add to dashboard Cite

show abstract

“…This overall favorable prognosis as well as the low prevalence of exposure to tobacco/alcohol underscores the importance of reducing treatment-related toxicity in this population. The benefit of protons in reducing acute and chronic treatment-related toxicities and patient-related quality-of-life measures has been demonstrated in several institutional case series [16,18]. The demonstrated reduction in the risk of SMNs is an additional advantage of protons.…”

Section: Discussionmentioning

confidence: 95%

Predicted Secondary Malignancies following Proton versus Photon Radiation for Oropharyngeal Cancers

Jain

Irmen

O’Reilly

et al. 2020

International Journal of Particle Therapy

Self Cite

View full text Add to dashboard Cite

Purpose There has been a recent epidemic of human papillomavirus (HPV)–positive oropharyngeal cancer, accounting for 70% to 80% of diagnosed cases. These patients have an overall favorable prognosis and are typically treated with a combination of surgery, chemotherapy, and radiation. Because these patients live longer, they are at risk of secondary malignant neoplasms (SMNs) associated with radiation therapy. Therefore, we assessed the predicted risk of SMNs after adjuvant radiation therapy with intensity-modulated proton therapy (IMPT) compared with intensity modulated photon radiation therapy (IMRT) in patients with HPV- positive oropharyngeal cancers after complete resection. Materials and Methods Thirteen consecutive patients with HPV-positive oropharyngeal cancers treated with postoperative radiation alone were selected. All patients were treated with pencil beam scanning IMPT to a total dose of 60 Gy in 2 Gy fractions. The IMRT plans were generated for clinical backup and were used for comparative purposes. The SMN risk was calculated based on an organ equivalent dose model for the linear-exponential dose-response curve. Results Median age of the patient cohort was 63 years (range, 47-73 years). There was no difference in target coverage between IMPT and IMRT plans. We noted significant reductions in mean mandible, contralateral parotid, lung and skin organ equivalent doses with IMPT compared with IMRT plans (P < .001). Additionally, a significant decrease in the risk of SMNs with IMPT was observed for all the evaluated organs. Per our analysis, for patients with oropharyngeal cancers diagnosed at a national median age of 54 years with an average life expectancy of 27 years (per national Social Security data), 4 excess SMNs per 100 patients could be avoided by treating them with IMPT versus IMRT. Conclusions Treatment with IMPT can achieve comparable target dose coverage while significantly reducing the dose to healthy organs, which can lead to fewer predicted SMNs compared with IMRT.

show abstract

“…However, the difference was only significant within the first year following treatment. The change for xerostomia was found to be no longer significant after the acute phase [24] and the number of domains remained significantly worse for photon therapy after the acute phase was also reduced [27, 37]. At least three hypotheses can be made from this observation.…”

Section: Discussionmentioning

confidence: 99%

Quality of life and patient-reported outcomes following proton therapy for oropharyngeal carcinoma: a systematic review

Yahya

Manan

2020

Preprint

View full text Add to dashboard Cite

Background: Complex anatomy surrounding the oropharynx makes proton therapy (PT) especially intensity-modulated PT (IMPT) a good option due to its ability to reduce the volume of irradiated healthy tissues. Dosimetric improvement may not translate to clinically relevant benefit. As outcome data are emerging, we aimed to systematically review current evidence of the quality of life (QOL) and patient-reported outcomes (PRO) following PT of oropharyngeal carcinoma (OC). Materials and Methods: We searched PubMed and Scopus electronic databases to identify eligible reports on QOL and PRO following PT of OC according to PRISMA guidelines. Reports were extracted for information on demographics, main results and clinical and dose factors correlates. Results: Six reports were selected from which four compared between PT and photon-based therapy. All endpoints where significant differences were found favour PT. The change following treatment improves but never to the baseline level. Conclusion: Available evidence suggests that PT causes less QOL deterioration and PRO compared to photon therapy. Whether or not it is cost-effective should be a subject of further investigation. Keywords: proton therapy; oropharyngeal carcinoma; patient-reported outcomes, quality of life

show abstract

Quality of Life of Postoperative Photon versus Proton Radiation Therapy for Oropharynx Cancer

Cited by 34 publications

References 21 publications

Proton Therapy for Locally Advanced Oropharyngeal Cancer: Initial Clinical Experience at the University of Washington

Proton Therapy for Locally Advanced Oropharyngeal Cancer: Initial Clinical Experience at the University of Washington

Predicted Secondary Malignancies following Proton versus Photon Radiation for Oropharyngeal Cancers

Quality of life and patient-reported outcomes following proton therapy for oropharyngeal carcinoma: a systematic review

Contact Info

Product

Resources

About