Abstract
The purpose of this study was to analyze national trends and disparities in proton therapy use among patients with head and neck cancer receiving radiotherapy to primary disease sites. Using the National Cancer Database, we identified patients diagnosed with any nonmetastatic head and neck primary malignancy between 2005 and 2014 who were treated with radiation therapy or proton therapy directed specifically at the primary disease site. Distributions of patient and clinical factors between the two groups were evaluated. Multivariable logistic regression was used to correlate factors associated with proton therapy use compared with other modalities of radiation therapy. There were 220 491 patients who received any radiation therapy as part of their initial treatment course, only 417 (0.2%) of whom received proton therapy. The use of protons underwent a small increase from 0.13% in 2005-06 to 0.41% by 2013-14 (P < .001). The most common primary sites treated with proton therapy were the nasal cavity/nasopharynx (n = 151, 36.2%) and the oral cavity (n = 98, 23.5%). Most patients had T4 disease (n = 94, 31.0%). On multivariable logistic regression, all primary sites compared with hypopharynx/larynx sites (odds ratio [OR], 2.53-10.53; P < .001), treatment at an academic facility (OR, 2.54; P < .001), ≥ 13-mile distance from the treating facility (OR, 1.94; P < .001), and highest median household income quartile (> $63 000; OR, 2.52; P = .002) were associated with an increased likelihood of receiving proton therapy. Proton use has undergone an incremental increase in the United States but remains an uncommon modality for the treatment of primary head and neck cancer.
Highlights
Radiation therapy (RT) is an important component in the treatment of head and neck cancers
It is estimated that 70% of all diagnosed malignancies in the United States are captured by facilities participating in this registry and reported to the National Cancer Database (NCDB)
Among those who received all other forms of radiation, 106 320 (48.2%) received Intensity-modulated radiation therapy (IMRT), 8443 (3.8%) received 3D-CRT, 559 (0.3%) received brachytherapy, 214 (0.1%) received radiosurgery, and the rest received forms of external beam radiation for which the specific modality was not specified
Summary
Radiation therapy (RT) is an important component in the treatment of head and neck cancers. Proton therapy use for head and neck cancer. Intensity-modulated radiation therapy (IMRT) is widely accepted as the predominant RT technique to optimize the therapeutic ratio for head and neck cancers. The characteristic sharp falloff in exit dose after the high-dose proton therapy has been deposited in the target has been shown to decrease toxicities in head and neck cancers. A study by van der Laan et al [1] found that patients treated with intensity-modulated proton therapy had decreased dose to the pharyngeal constrictors, resulting in decreased rates of dysphagia compared with IMRT. Several comparison studies [2,3,4,5] have shown lower energy delivered to regions outside the target and, lower integral dose with proton therapy
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