Spot-scanning beam proton therapy vs intensity-modulated radiation therapy for ipsilateral head and neck malignancies: A treatment planning comparison

Kandula, Shravan; Zhu, Xiaorong Ronald; Garden, Adam S.; Gillin, Michael; Rosenthal, David I.; Ang, K. Kian; Mohan, Radhe; Amin, M.; Garcia, J.; Wu, Richard; Sahoo, Narayan; Frank, Steven J.

doi:10.1016/j.meddos.2013.05.001

Cited by 92 publications

(71 citation statements)

References 23 publications

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“…More recently, numerous reports have been published documenting the theoretical advantages of proton therapy over photon therapy for head and neck cancer [23–25]. The first use of multi-field optimization for IMPT was reported in 2014 for head and neck malignancies [16]; indeed, IMPT (as opposed to passively scattered proton therapy) has been shown in treatment-planning comparisons to be the most effective in reducing the doses to the spinal cord, parotid, and brainstem [13, 26]. Although patients in our retrospective analysis had not been randomized to receive one type of therapy over the other, our results demonstrated a clear reduction in mean mandibular dose with IMPT (25.6 Gy vs. 41.2 Gy for IMRT, P <0.001), as well as a reduction of the volume of the mandible exposed to high radiation doses between 60 and 70 Gy, which are known to be related to the occurrence of ORN.…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Zhang

Yang

et al. 2017

Radiotherapy and Oncology

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Purpose We compared mandibular doses and osteoradionecrosis in patients with oropharyngeal cancer after intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT). Methods and materials We identified 584 patients who received definitive radiotherapy for oropharyngeal cancer from January 2011 through June 2014 at MD Anderson Cancer Center (534 IMRT and 50 IMPT). The dosimetric variables and osteoradionecrosis were compared with Chi-square test or Fisher’s exact test. Results Median follow-up time for all patients (534 IMRT and IMPT) was 33.8 months (33.8 months IMRT vs. 34.6 months IMPT, P=0.854), and median time to osteoradionecrosis was 11.4 months (range 6.74–16.1 months). Mandibular doses were lower for patients treated with IMPT (minimum 0.8 vs. 7.3 Gy; mean 25.6 vs. 41.2 Gy; P<0.001), and osteoradionecrosis rates were lower as well: 2% IMPT (1 grade 1), 7.7% IMRT (12 grade 4, 5 grade 3, and 1 grade 2 and 23 grade 1). Osteoradionecrosis location depended on the primary tumor site and high-dose field in the mandible. Conclusions: Osteoradionecrosis events were significantly associated with higher dose irradiation to mandibular Use of IMPT minimized excess irradiation of the mandible and consequently reduced the risk of osteoradionecrosis for oropharyngeal cancer.

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Section: Discussionmentioning

confidence: 99%

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Zhang

Yang

et al. 2017

Radiotherapy and Oncology

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“…A larger dosimetric advantage with proton therapy use is appreciable in the setting of ipsilateral treatment targets, such as salivary tumors or early tonsillar tumors. 6 In a study by Romesser et al, 7 41 patients who underwent ipsilateral RT for major salivary gland cancer or cutaneous squamous cell carcinoma were examined, 56% treated with IMRT and 44% with proton beam RT (PBRT The two groups, however, were not well balanced as higher risk histologies were in the photon group and the dose delivered was equivalent. These results are encouraging and emphasize the need for more randomized trials in various head and neck subsites.…”

Section: 5005/jp-journals-10001-1305mentioning

confidence: 99%

Proton Therapy in the Treatment of Head and Neck Cancer

Katsoulakis¹,

Chernichenko²,

Schreiber³

et al. 2017

International Journal of Head and Neck Surgery

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Aim:To examine the value of proton therapy in relation to other treatment modalities in head and neck cancer.Review: Proton therapy has evolved into more sophisticated and costly intensity-modulated proton therapy and has resulted in even greater dose reduction to normal critical structures at risk as compared with photon therapy. Early clinical studies in head and neck cancers, especially for tumors of the skull base and paranasal sinuses, suggest that proton therapy is excellent in terms of local control and is comparable to intensity-modulated radiation therapy photons but with lower rates of morbidity.Results: There are many potential advantages to radiation therapy with protons. While there are many single institution studies examining the added value of protons to photon therapy, the value of proton therapy must be examined in prospective randomized clinical studies and across many subsites of head and neck cancer. Additional evidence is necessary to guide efficient clinical practice, patient selection, and tumors that are most likely to benefit from this treatment modality and justify proton therapy use given its significant cost.

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“…On the other hand, grade 3 optic nerve damage and cataracts developed in 1 and 2 patients, respectively, who received PBT. Previous studies have demonstrated the usefulness for spot-scanning proton therapy to significantly reduce the integral dose to head and neck critical structures (19,20), and prospective studies are underway to determine if this reduced dose translates to an improved quality of life in patients.…”

Section: A B C Dmentioning

confidence: 99%

Proton beam therapy for locally advanced and unresectable (T4bN0M0) squamous cell carcinoma of the ethmoid sinus: A report of seven cases and a literature review

Saito¹,

Ishikawa²,

Ohnishi³

et al. 2015

Oncology Letters

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Abstract. The present study reports treatment outcomes of locally advanced and unresectable squamous cell carcinoma of the ethmoid sinus (SCC-ES) following proton beam therapy (PBT). Between January 1997 and December 2012, 7 patients (median age, 63 years) with SCC-ES underwent definitive PBT. All tumors were categorized as T4bN0M0 (2009 UICC tumor-node-metastasis classification) and were treated using conventional fractionation at a median total dose of 72 Gy equivalents (GyE; range,. Imaging diagnosis for the initial treatment effect within 3 months of PBT revealed that a complete response (CR) was achieved in 2 patients and a partial response (PR) in 5 patients. The overall median survival time of the patients was 43 months (range, 12-62 months), and 4 patients survived for ≥3 years. No recurrence was observed in the 2 patients who exhibited an initial CR treatment effect; however, locoregional recurrences occurred in 4/5 patients who exhibited a PR. No grade 3 or severe acute toxicities were observed, but the late toxicities of grade 3 contralateral optic nerve damage and cataracts developed in 1 and 2 patients, respectively. Based on the findings of the present study, intensification of the local treatment effect may be important for yielding favorable treatment outcomes, since no distant metastasis was observed. PBT is therefore a potentially useful treatment tool for unresectable SCC-ES. IntroductionMalignancies of the paranasal cavity are rare, representing ~3% of all head and neck cancers and ≤1% of total malignancies; the combination of surgery, chemotherapy and radiation therapy (RT) has been widely used in patients with the disease (1-3). Among paranasal cavity malignancies, cancer of the ethmoid sinus complex is even rarer, and surgical approaches are usually complicated by a lack of satisfactory surgical clearance and the risk of serious dysfunction of the surrounding normal tissues, including the brain stem and optic nerve (4). Consequently, definitive RT for patients with unresectable squamous cell carcinoma of the ethmoid sinus (SCC-ES) has been performed, but it can be difficult to deliver a curative irradiation dose to the tumor without severe complications, such as visual loss and brain necrosis, among others (5). Thus, there is little information on the efficacy of RT for SCC-ES at present.Proton beam therapy (PBT) offers advantageous physical properties to RT for a variety of cancers. Since proton beams exhibit a spread-out Bragg peak and achieve an improved dose distribution of the target volume using specified beam modulations compared with photon beams (6-10), PBT delivers a large irradiation dose to the tumor using limited numbers of portals while sparing the surrounding normal tissues. Hence, the technique may yield improved disease control with minimum morbidity compared with previous conventional RT (11). A number of previous studies have reported favorable outcomes for patients with head and neck cancers treated with PBT (8-10), but SCC-ES has not been an area of focus, as there is ...

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Spot-scanning beam proton therapy vs intensity-modulated radiation therapy for ipsilateral head and neck malignancies: A treatment planning comparison

Cited by 92 publications

References 23 publications

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer

Proton Therapy in the Treatment of Head and Neck Cancer

Proton beam therapy for locally advanced and unresectable (T4bN0M0) squamous cell carcinoma of the ethmoid sinus: A report of seven cases and a literature review

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