Intensity-modulated radiotherapy of nasopharyngeal carcinoma: a comparative treatment planning study of photons and protons

Taheri-Kadkhoda, Zahra; Björk‐Eriksson, Thomas; Nill, Simeon; Wilkens, Jan J.; Oelfke, Uwe; Johansson, K.-A.; Huber, Peter E.; Münter, Marc W.

doi:10.1186/1748-717x-3-4

Cited by 108 publications

(88 citation statements)

References 43 publications

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“…In one study [12], dose constraints were defined only for critical neural structures, whereas in the other two studies dose constraints for several other OARs, including the parotid glands, were taken into account. In two studies [12,13], target dose coverage and dose conformity were significantly better using protons, whereas the target dose could be escalated without exceeding the tolerance dose of critical structures [12]. In all studies, the dose to all OARs could be markedly lower (Table 2).…”

Section: Nasopharyngeal Cancermentioning

confidence: 95%

“…Third, most authors only presented average results for all cases [9,13,14,16,18]. It should be noted that the benefit of a new technique in terms of dose distributions in targets and OARs will depend on a number of factors, such as the volume and shape of the target, the position of the target reference to OARs, and the amount of overlap between the PTV and a given OAR.…”

Section: Discussionmentioning

confidence: 99%

“…In all studies, the dose to all OARs could be markedly lower (Table 2). Of note is that the medium-to-low dose volume or the mean dose to the total body was lower with IMPT than with IMRT [13,14], although the exact definition of this endpoint remained unclear.…”

Section: Nasopharyngeal Cancermentioning

confidence: 99%

“…Three studies were identified reporting on ISPC studies among patients with nasopharyngeal carcinoma (Table 1), including a total of 16 patients [12][13][14]. In one study, 3D-CRT was compared with mixed photon-scattered proton plans, whereas in the other two studies, three-field IMPT was compared with IMRT and HT.…”

Section: Nasopharyngeal Cancermentioning

confidence: 99%

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The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

et al. 2011

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Purpose. Clinical studies concerning head and neck cancer patients treated with protons reporting on radiation-induced side effects are scarce. Therefore, we reviewed the literature regarding the potential benefits of protons compared with the currently used photons in terms of lower doses to normal tissue and the potential for fewer subsequent radiation-induced side effects, with the main focus on in silico planning comparative (ISPC) studies.Materials and Methods. A literature search was performed by two independent researchers on ISPC studies that included proton-based and photon-based irradiation techniques.Results. Initially, 877 papers were retrieved and 14 relevant and eligible ISPC studies were identified and included in this review. Four studies included paranasal sinus cancer cases, three included nasopharyngeal cancer cases, and seven included oropharyngeal, hypopharyngeal, and/or laryngeal cancer cases. Seven studies compared the most sophisticated photon and proton techniques: intensity-modulated photon therapy versus intensity-modulated proton therapy (IMPT). Four studies compared different proton techniques. All studies showed that protons had a lower normal tissue dose, while keeping similar or better target coverage. Two studies found that these lower doses theoretically translated into a significantly lower incidence of salivary dysfunction.Conclusion. The results of ISPC studies indicate that protons have the potential for a significantly lower normal tissue dose, while keeping similar or better target coverage. Scanned IMPT probably offers the most advantage and will allow for a substantially lower probability of radiation-induced side effects. The results of these ISPC studies should be confirmed in properly designed clinical trials. The Oncologist 2011;16:366 -377

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Section: Nasopharyngeal Cancermentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Nasopharyngeal Cancermentioning

confidence: 99%

Section: Nasopharyngeal Cancermentioning

confidence: 99%

See 2 more Smart Citations

The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

et al. 2011

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“…[20] For oropharyngeal cancer and nasopharyngeal cancer, the treatment target does not include the brain, oral cavity, submandibular gland, or esophagus. Compared to IMRT, IMPT spares substantial dose to these regions [23] and preliminary results were very encouraging for using this technique. [22] The result of a recent study showed that the percentage of oropharyngeal cancer patients requiring nasogastric tube feeding during concurrent chemoradiotherapy (CCRT) was significantly reduced from 46% by IMRT to 19% by IMPT.…”

Section: Head and Neck Cancers Including Nasopharyngeal Carcinomamentioning

confidence: 94%

What are the potential benefits of using proton therapy in Taiwanese cancer patients?

2015

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Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy

Kitpanit

Lee

et al. 2021

JAMA Netw Open

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IMPORTANCE Patients with nonmetastatic nasopharyngeal carcinoma (NPC) are primarily treated by radiotherapy with curative intent with or without chemotherapy and often experience substantial treatment-related toxic effects even with modern radiation techniques, such as intensitymodulated radiation therapy (IMRT). Intensity-modulated proton therapy (IMPT) may improve the toxicity profile; however, there is a paucity of data given the limited availability of IMPT in regions with endemic NPC. OBJECTIVE To compare toxic effects and oncologic outcomes among patients with newly diagnosed nonmetastatic NPC when treated with IMPT vs IMRT with or without chemotherapy. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study included 77 patients with newly diagnosed nonmetastatic NPC who received curative-intent radiotherapy with IMPT or IMRT at a tertiary academic cancer center from January 1, 2016, to December 31, 2019. Forty-eight patients with Epstein-Barr virus (EBV)-positive tumors were included in a 1:1 propensity score-matched analysis for survival outcomes. The end of the follow-up period was March 31, 2021.EXPOSURES IMPT vs IMRT with or without chemotherapy. MAIN OUTCOMES AND MEASURESThe main outcomes were the incidence of acute and chronic treatment-related adverse events (AEs) and oncologic outcomes, including locoregional failure-free survival (LRFS), progression-free survival (PFS), and overall survival (OS). RESULTSWe identified 77 patients (25 [32.5%] women; 52 [67.5%] men; median [interquartile range] age, 48.7 [42.2-60.3] years), among whom 28 (36.4%) were treated with IMPT and 49(63.6%) were treated with IMRT. Median (interquartile range) follow-up was 30.3 (17.9-41.5) months.On multivariable logistic regression analyses, IMPT was associated with lower likelihood of developing grade 2 or higher acute AEs compared with IMRT (odds ratio [OR], 0.15; 95% CI, 0.03-0.60; P = .01). Only 1 case (3.8%) of a chronic grade 3 or higher AE occurred in the IMPT group compared with 8 cases (16.3%) in the IMRT group (OR, 0.21; 95% CI, 0.01-1.21; P = .15). Propensity score matching generated a balanced cohort of 48 patients (24 IMPT vs 24 IMRT) and found similar PFS in the IMPT and IMRT groups (2-year PFS, 95.7% [95% CI, 87.7%-100%] vs 76.7% [95% CI, 60.7%-97.0%]; hazard ratio [HR], 0.31; 95% CI, 0.07-1.47; P = .14). No locoregional recurrence or death was observed in the IMPT group from the matched cohort. Two-year LRFS was 100% (95% CI, 100%-100%) in the IMPT group and 86.2% (95% CI, 72.8%-100%) in the IMRT group (P = .08).Three-year OS was 100% (95% CI, 100%-100%) in the IMPT group and 94.1% (95% CI, 83.6%-100%) in the IMRT group (P = .42). Smoking history was the only clinical factor significantly (continued) Key Points Question Is intensity-modulated proton therapy (IMPT) associated with fewer treatment-related adverse events and comparable oncologic outcomes for patients with nonmetastatic nasopharyngeal carcinoma (NPC) compared with patients treated with intensity-modulated radiation therapy (IMRT)? Findin...

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Intensity-modulated radiotherapy of nasopharyngeal carcinoma: a comparative treatment planning study of photons and protons

Abstract: Background: The aim of this treatment planning study was to investigate the potential advantages of intensity-modulated (IM) proton therapy (IMPT) compared with IM photon therapy (IMRT) in nasopharyngeal carcinoma (NPC).

Cited by 108 publications

References 43 publications

The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

What are the potential benefits of using proton therapy in Taiwanese cancer patients?

Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy

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