Intensity‐modulated proton therapy for nasopharyngeal carcinoma: Decreased radiation dose to normal structures and encouraging clinical outcomes

Lewis, Gary D.; Holliday, Emma B.; Kocak–Uzel, Esengul; Hernandez, Mike; Garden, Adam S.; Rosenthal, David I.; Frank, Steven J.

doi:10.1002/hed.24341

Cited by 110 publications

(106 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In particular, the application of intensity-modulated proton therapy is being actively studied, as some dosimetric and clinical studies have shown its potential in reirradiation. [28][29][30]…”

Section: Discussionmentioning

confidence: 99%

Reirradiation with intensity‐modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma

et al. 2016

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Reirradiation with intensity‐modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma

et al. 2016

View full text Add to dashboard Cite

show abstract

“…75,76 Specifically for NPC, proton therapy has established dosimetric superiority, although trials are ongoing to determine the level of clinical benefit. 77 However, without high-quality prospective comparative data, it is premature to conclude that proton therapy has been established as superior to other modern radiation techniques, such as IMRT. For the 2018 NCCN Guidelines update, the panel added a statement that proton therapy may be considered for treatment of NPC when normal tissue constraints cannot be met by photon-based therapy (see NASO-A, page 483).…”

Section: Radiation Therapymentioning

confidence: 99%

NCCN Guidelines Insights: Head and Neck Cancers, Version 1.2018

Colevas¹,

Yom²,

Pfister³

et al. 2018

J Natl Compr Canc Netw

477

411

View full text Add to dashboard Cite

The NCCN Guidelines for Head and Neck (H&N) Cancers provide treatment recommendations for cancers of the lip, oral cavity, pharynx, larynx, ethmoid and maxillary sinuses, and salivary glands. Recommendations are also provided for occult primary of the H&N, and separate algorithms have been developed by the panel for very advanced H&N cancers. These NCCN Guidelines Insights summarize the panel's discussion and most recent recommendations regarding evaluation and treatment of nasopharyngeal carcinoma.

show abstract

“…For a target that has been customized following induction chemotherapy, proton therapy provides the added advantage of decreasing the low to intermediate radiation dose to adjacent organs, thereby potentially reducing acute and late toxicities. Lewis et al conducted a dosimetric comparison of patients with NPC and showed a mean radiation dose that was significantly reduced to 13 OARs with the proton‐based plans over the photon‐based IMRT plans . Holliday et al published a case‐match control study of intensity‐modulated proton therapy (IMPT) and IMRT .…”

Section: Discussionmentioning

confidence: 99%

“…Lewis et al conducted a dosimetric comparison of patients with NPC and showed a mean radiation dose that was significantly reduced to 13 OARs with the proton-based plans over the photon-based IMRT plans. 12 Holliday et al published a case-match control study of intensity-modulated proton therapy (IMPT) and IMRT. 13 Among 30 patients between ages 18 and 59 years, 10 patients were treated with IMPT and 20 matched patients were treated with IMRT.…”

Section: Discussionmentioning

confidence: 99%

“…Proton therapy allows for a decrease in the low to intermediate radiation dose to normal tissue outside of the target volume. In patients with NPC, multiple dosimetric studies have illustrated the reduced radiation dose to various organs at risk (OARs) with proton‐based plans compared to photon‐based intensity‐modulated radiotherapy (IMRT) plans . The physical properties of protons may be particularly beneficial in vulnerable pediatric patients with NPC for whom the target volume is surrounded by valuable radiosensitive organs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma

Uezono

Indelicato

Rotondo

et al. 2019

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Purpose In children treated for nasopharyngeal carcinoma, proton therapy and postchemotherapy target volumes can reduce the radiation dose to developing tissue in the brain and the skull base region. We analyzed outcomes in children with nasopharyngeal carcinoma treated with induction chemotherapy followed by moderate‐dose proton therapy. Methods/Materials Seventeen patients with nonmetastatic nonkeratinizing undifferentiated/poorly differentiated nasopharyngeal carcinoma underwent double‐scattered proton therapy between 2011 and 2017. Median age was 15.3 years (range, 7‐21). The American Joint Committee on Cancer T and N stage distribution included the following: T1, one patient; T2, five patients; T3, two patients; and T4, nine patients; and N1, six patients; N2, nine patients; and N3, two patients. Median radiation dose to the primary target volume and enlarged lymph nodes was 61.2 Gy (range, 59.4‐61.2). Uninvolved cervical nodes received 45 Gy (range, 45‐46.8). All radiation was delivered at 1.8 Gy/fraction daily using sequential plans. In 11 patients, photon‐based intensity‐modulated radiotherapy was used for elective neck irradiation to optimize dose homogeneity and improve target conformity. All patients received induction chemotherapy; all but one received concurrent chemotherapy. Five received adjuvant beta‐interferon therapy. Results Median follow‐up was 3.0 years (range, 1.6‐7.9). No patients were lost to follow‐up. Overall survival, progression‐free survival, and local control rates were 100%. Fifteen patients developed mucositis requiring enteral feeding (n = 14) or total parenteral nutrition (n = 1) during radiotherapy. Serious late side effects included cataract (n = 1), esophageal stenosis requiring dilation (n = 1), sensorineural hearing loss requiring aids (n = 1), and hormone deficiency (n = 5, including three with isolated hypothyroidism). Conclusion Following induction chemotherapy, moderate‐dose proton therapy can potentially reduce toxicity in the brain and skull base region without compromising disease control. However, further follow‐up is needed to fully characterize and evaluate any reduction in long‐term complications.

show abstract

Intensity‐modulated proton therapy for nasopharyngeal carcinoma: Decreased radiation dose to normal structures and encouraging clinical outcomes

Abstract: We observed dosimetric advantages conferred by IMPT compared to IMRT. Further study is needed to determine if these translate into reduced toxicity and/or improved disease control. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1886-E1895, 2016.

Cited by 110 publications

References 34 publications

Reirradiation with intensity‐modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma

Reirradiation with intensity‐modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma

NCCN Guidelines Insights: Head and Neck Cancers, Version 1.2018

Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma

Contact Info

Product

Resources

About