Abstract
BackgroundTo evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT).MethodsForty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation.ResultsIn a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus.ConclusionsProton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life endpoints.
Highlights
To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT)
Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements
To quantify potential objective differences in acute toxicity, we reviewed our experience in treatment of patients with paranasal sinus and nasopharyngeal tumors receiving comprehensive head and neck radiation therapy using one of three techniques: IMRT, protons to the primary tumor site with concurrent matched IMRT to the neck, or comprehensive head and neck proton therapy alone
Summary
To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT). Proton therapy is a modality of radiation therapy distinguished from X-ray modalities by the Bragg peak, which allows the radiation to penetrate in to the depth of the target and terminate, sparing normal tissues beyond the target from unnecessary radiation [10]. This has been hypothesized to improve the therapeutic ratio of treatment in a number of disease sites [11]. To quantify potential objective differences in acute toxicity, we reviewed our experience in treatment of patients with paranasal sinus and nasopharyngeal tumors receiving comprehensive head and neck radiation therapy using one of three techniques: IMRT, protons to the primary tumor site with concurrent matched IMRT to the neck, or comprehensive head and neck proton therapy alone
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