Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer

Manzar, Gohar; Lester, Scott C.; Routman, David M.; Harmsen, William S.; Petersen, M.; Sloan, Jeff A.; Mundy, Daniel W.; Hunzeker, Ashley; Amundson, A.; Anderson, Jeffrey L.; Patel, Samir H.; Garces, Yolanda I.; Halyard, Michele Y.; McGee, L.A.; Neben-Wittich, M.A.; Daniel, J.; Frank, Steven J.; Whitaker, Thomas J.; Foote, Robert L.

doi:10.1016/j.radonc.2020.03.010

Cited by 46 publications

(50 citation statements)

References 29 publications

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“…However, Christianen et al reported that the reduction of normal tissue complication probability for grade >2 late dysphagia at 6 months after RT was only 4.9% with swallowing sparing IMRT compared to standard parotid sparing IMRT [7]. Intensitymodulated proton therapy (IMPT) may have a potential advantage in reducing side effects compared to IMRT and VMAT [27][28][29]. However, with regard to late dysphagia, IMPT may have more benefits in the upper head and neck cancers like oropharyngeal cancer [27].…”

Section: Discussionmentioning

confidence: 99%

Death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy for head and neck cancer

Kanayama

Otozai²,

Yoshii³

et al. 2020

Radiotherapy and Oncology

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Background and purpose: The incidence of hypopharyngeal and supraglottic cancer (HSC) is high in Japan. This study aimed to retrospectively identify risk factors for death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy (RT) for HSC. Materials and methods: Overall, 391 patients who began definitive RT for HSC between 2006 and 2014 were identified from the Osaka International Cancer Institute electronic database. Among 391 patients, 33 had a history of surgery for esophageal cancer (EC) and 19 received simultaneous RT for synchronous EC. The cause of death was divided into 3 main categories: ''cancer under study," ''other malignancy," and ''unrelated to cancer." Cox proportional hazard model was used to estimate the hazard ratio (HR). Results: The median follow-up for survivors was 8 (range 3.6-14.1) years. At the last follow-up, 202 patients died. Death from ''cancer under study," ''other malignancy," and ''unrelated to cancer" occurred in 92 (45.5%), 55 (27.2%), and 55 (27.2%) patients, respectively. Twelve patients died from aspiration pneumonia. In multivariate analysis for death unrelated to cancer and death from aspiration pneumonia, history of surgery for EC (HR: 3.87, p < 0.001; HR: 6.84, p = 0.007, respectively) and simultaneous RT for synchronous EC (HR: 3.74, p = 0.006; HR: 16.37, p < 0.001, respectively) were significant risk factors. Conclusion: The laryngeal preservation approach by RT for HSC patients with a history of surgery for EC and simultaneous RT for synchronous EC should be used with caution.

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Section: Discussionmentioning

confidence: 99%

Death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy for head and neck cancer

Kanayama

Otozai²,

Yoshii³

et al. 2020

Radiotherapy and Oncology

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“…At median follow-up times of 30 months for patients treated with VMAT and 12 months for those treated with IMPT, the 1-Table 2. Side effect rates after IMPT for OPC (Aljabab [58]) and side effect comparison of IMPT versus IMRT/VMAT for OPC (Blanchard [59], Manzar [61], Sio [63]) [62,63]. Differences in proportions of patients experiencing decreased appetite favored IMPT at two intervals after treatment, first within 3 months of treatment completion (MDASI-HN average score 4.68 versus 6.37, P=0.048) and later at more than 3 months after treatment completion (MDASI-HN average score 2.12 versus 4.14, P=0.036).…”

Section: Case-control Studiesmentioning

confidence: 99%

“…Manzar et al compared acute toxicities and patient-reported outcomes for 305 OPC patients treated with VMAT ( n = 259) or IMPT ( n = 46) at the Mayo Clinic from 2013 to 2018 with either 70 Gy definitively or 60–66 Gy postoperatively [ 61 ]. Analysis of feeding tube rates during and within 30 days of radiotherapy completion demonstrated lower use among patients treated with IMPT (19.6% versus 46.3%, OR = 0.27, 95% CI 0.12–0.59, P =0.001).…”

Section: Proton Therapy For Oropharyngeal Cancermentioning

confidence: 99%

Proton Therapy for HPV-Associated Oropharyngeal Cancers of the Head and Neck: a De-Intensification Strategy

Taku

Wang

Garden

et al. 2021

Curr. Treat. Options in Oncol.

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Opinion statementThe rise in the incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC), the relatively young age at which it is diagnosed, and its favorable prognosis necessitate the use of treatment techniques that reduce the likelihood of side effects during and after curative treatment. Intensity-modulated proton therapy (IMPT) is a form of radiotherapy that de-intensifies treatment through dose de-escalation to normal tissues without compromising dose to the primary tumor and involved, regional lymph nodes. Preclinical studies have demonstrated that HPV-positive squamous cell carcinoma is more sensitive to proton radiation than is HPV-negative squamous cell carcinoma. Retrospective studies comparing intensity-modulated photon (X-ray) radiotherapy to IMPT for OPC suggest comparable rates of disease control and lower rates of pain, xerostomia, dysphagia, dysgeusia, gastrostomy tube dependence, and osteoradionecrosis with IMPT—all of which meaningfully affect the quality of life of patients treated for HPV-associated OPC. Two phase III trials currently underway—the “Randomized Trial of IMPT versus IMRT for the Treatment of Oropharyngeal Cancer of the Head and Neck” and the “TOxicity Reduction using Proton bEam therapy for Oropharyngeal cancer (TORPEdO)” trial—are expected to provide prospective, level I evidence regarding the effectiveness of IMPT for such patients.

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“…Moreover, IMPT takes advantage of the unique physical properties of protons (Bragg peak), allowing minimal radiation exit doses and sparing surrounding healthy tissues from resultant toxicity [18,19]. Prior observational studies of patients with OPC have demonstrated that IMPT was associated with lower risks of dry mouth, swallowing difficulties, damaged taste, and feeding-tube dependence, with equivalent cancer survival rates when compared with conventional IMRT [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Work Outcomes after Intensity-Modulated Proton Therapy (IMPT) versus Intensity-Modulated Photon Therapy (IMRT) for Oropharyngeal Cancer

Smith

Ning

et al. 2021

International Journal of Particle Therapy

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Purpose We compared work outcomes in patients with oropharyngeal cancer (OPC), randomized to intensity-modulated proton (IMPT) versus intensity-modulated photon therapy (IMRT) for chemoradiation therapy (CRT). Patients and Methods In 147 patients with stage II-IVB squamous cell OPC participating in patient-reported outcomes assessments, a prespecified secondary aim of a randomized phase II/III trial of IMPT (n = 69) versus IMRT (n = 78), we compared absenteeism, presenteeism (i.e., the extent to which an employee is not fully functional at work), and work productivity losses. We used the work productivity and activity impairment questionnaire at baseline (pre-CRT), at the end of CRT, and at 6 months, 1 year, and 2 years. A one-sided Cochran-Armitage test was used to analyze within-arm temporal trends, and a χ2 test was used to compare between-arm differences. Among working patients, at each follow-up point, a 1-sided Wilcoxon rank-sum test was used to compare work-productivity scores. Results Patient characteristics in IMPT versus IMRT arms were similar. In the IMPT arm, within-arm analysis demonstrated that an increasing proportion of patients resumed working after IMPT, from 60% (40 of 67) pre-CRT and 71% (30 of 42) at 1 year to 78% (18 of 23) at 2 years (P = 0.025). In the IMRT arm, the proportion remained stable, with 57% (43 of 76) pre-CRT, 54% (21 of 39) at 1 year, and 52% (13 of 25) working at 2 years (P = 0.47). By 2 years after CRT, the between-arm difference between patients who had IMPT and those who had IMRT trended toward significance (P = 0.06). Regardless of treatment arm, among working patients, the most severe work impairments occurred from treatment initiation to the end of CRT, with significant recovery from absenteeism, presenteeism, and productivity impairments by the 2-year follow-up (P < 0.001 for all). Higher magnitudes of recovery from absenteeism (at 1 year, P = 0.05; and at 2 years, P = 0.04) and composite work impairment scores (at 1 year, P = 0.04; and at 2 years, P = 0.04) were seen in patients treated with IMPT versus those treated with IMRT. Conclusion In patients with OPC receiving curative CRT, patients randomized to IMPT demonstrated increasing work and productivity recovery trends. Studies are needed to identify mechanisms underlying head and neck CRT treatment causing work disability and impairment.

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Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer

Cited by 46 publications

References 29 publications

Death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy for head and neck cancer

Death unrelated to cancer and death from aspiration pneumonia after definitive radiotherapy for head and neck cancer

Proton Therapy for HPV-Associated Oropharyngeal Cancers of the Head and Neck: a De-Intensification Strategy

Work Outcomes after Intensity-Modulated Proton Therapy (IMPT) versus Intensity-Modulated Photon Therapy (IMRT) for Oropharyngeal Cancer

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