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Otorinolaringologia 2014 March;64(1):1-11


lingua: Inglese

Current applications of proton beam radiation for the treatment of head and neck tumors

Holliday E. B., Frank S. J.

Department of Radiation Oncology, Unit 97 the University of Texas, MD Anderson Cancer Center Houston, TX, USA


AIM: Even as an increasing number of proton therapy centers break ground across the USA and internationally, specific indications for the use of proton therapy are still debated. We here present our early institutional experience using proton beam radiation for tumors of the head and neck.
METHODS: A total of 106 patients with head and neck cancer treated with proton beam radiation between 2011 and 2013 were enrolled on a prospective, observational study at M.D. Anderson Cancer Center Proton Therapy Center. Patient charts and study questionnaires were reviewed to determine pretreatment characteristics, tumor characteristics, treatment details, response to treatment, toxicity, tumor control and survival.
RESULTS: Twenty-one patients (19.8%) had periorbital tumors, 16 (15.1%) had sinonasal tumors, 13 (12.3%) had parotid tumors, 13 (12.3%) had nasopharyngeal tumors, 31 (29.2%) had oropharyngealtumors, and 12 (11.3%) had tumors in other head and neck locations. Eighty-one patients (76.4%) had newly diagnosed head and neck cancer, and 25 (23.6%) patients had recurrent disease. Sixty-one (57.5%) received surgery, 21 (19.8%) received induction chemotherapy, and 56 (52.8%) received concurrent chemoradiation. The median dose was 66 Gy(RBE), range 30-70 Gy(RBE). Eighteen of 21 patients with periorbital tumors were treated with an orbit sparing approach, and none have required subsequent exenteration. Patients with parotid and paranasal sinus tumors, particularly with nerve involvement or disease near the base of the skull were able to tolerate curative radiation doses with no significant acute toxicity. Oropharyngeal and nasopharyngeal cancer patients had low rates of gastrostomy tube insertion (22.6% and 23.1%, respectively) and median percentage body weight loss during radiation (7.6% [range 14.3% lost to 4.5% gained] and 5.3% [range 1.1-14%], respectively). No patient developed grade 4 or 5 acute toxicity. Median follow-up was 11 months (range 1.3-27.9 months).
CONCLUSION: The unique physical properties of protons make them particularly useful for treating tumors in challenging locations close to non-target critical structures. Although preliminary, these data suggest proton beam radiation to be safe and well tolerated in the treatment of malignancies of the head and neck. Longer follow-up is required to better evaluate clinical outcomes such as tumor control, survival and quality of life.

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