Radiation Oncology/Head & Neck/Protons

Proton Therapy in Head & Neck Cancers General Tsukuba; 2004 (1983-2000) 14762662 -- "Proton therapy for head and neck malignancies at Tsukuba." (Tokuuye K, Strahlenther Onkol. 2004 Feb;180(2):96-101.) Retrospective. 33 patients with H&N malignancies, no surgery. Oral papillomatosis 12%, T1-2N0 21%, 67% locally advanced. Treated with protons +/- photons (depending on beam availability). Median dose 76 Gy, median proton dose 2.8 Gy/fraction. Outcome: 5-year LC 74%, 5-year OS 44% Toxicity: Grade 3+ acute 3%, late 18% Conclusion: High local control, with few toxicities compared with conventional RT. However, late toxicity if prior significant RT Specific Sites Nasopharynx Sinonasal tumors Adenoid cystic Oropharynx Treatment Planning Paul Scherrer Institute 2006 16916557 -- "Intensity modulated photon and proton therapy for the treatment of head and neck tumors." (Steneker M, Radiother Oncol. 2006 Aug;80(2):263-7. Epub 2006 Aug 17.) Treatment planning. 5 patients, comparison of IMPT (3, 5, 9 fields and 2 spot sizes) and IMRT (5, 9 fields) Outcome: Critical organs best spared using 3-field IMPT. Little advantage to more fields, but advantage to smaller spot size. Conclusion: IMPT better ability to spare organs at risk than IMRT for the same dose homogeneity 2001 11730999 -- "A treatment planning comparison of 3D conformal therapy, intensity modulated photon therapy and proton therapy for treatment of advanced head and neck tumours." (Cozzi L, Radiother Oncol. 2001 Dec;61(3):287-97.) Treatment planning. 5 patients, comparison of conventional photon/electron plan, 3D-CRT, IMRT, and proton therapy. PTV 54 Gy. Outcome: PTV coverage for all techniques but conventional photon/electron plan; protons improved dose homogeneity. For spinal cord and parotid, proton best sparing; IMRT plans superior to 3D-CRT and conventional plans, but inferior to proton plans. Conclusion: IMRT and protons have potential to reduce toxicity over conventional RT Review MAASTRO; 2010 20817407 -- "Systematic review and meta-analysis of radiotherapy in various head and neck cancers: Comparing photons, carbon-ions and protons." (Ramaekers BL, Cancer Treat Rev. 2010 Sep 1. [Epub ahead of print]) Systematic review. 86 observational studies (74 photon, 5 carbon, 7 proton), 8 comparative in-silico studies Outcome: 5-year OS higher after carbon ion for mucusalsimilar to mucosal September 2022 melanoma compared to photons (44% vs 25%, SS). 5-year LC higher for carbon compared with IMRT for paranasal/sinonasal tumors (88% vs 66%, SS). No other significant comparisons Conclusion: Overall quality and quantity of data regarding carbon and proton therapy is poor Harvard; 2008 18493920 -- "Proton radiation therapy for head and neck cancer." (Chan AW, J Surg Oncol. 2008 Jun 15;97(8):697-700.) Review; 2006 16804876 -- "Particle beam radiotherapy for head and neck tumors: radiobiological basis and clinical experience." (Jereczek-Fossa, Head Neck. 2006 Aug;28(8):750-60.) Charged Particles Chiba 2008 18769999 -- "Comparative study of dose distribution between carbon ion radiotherapy and photon radiotherapy for head and neck tumor." (Amirul Islam, Radiat Med. 2008 Aug;26(7):415-21. Epub 2008 Sep 4.) Treatment planning. 7 patients originally treated with carbon ion (sinonasal tumors). Carbon ion (CIRT) vs. 3D-CRT vs. IMRT. Outcome: Mean conformity index 3D-CRT 1.46, IMRT 1.43, CIRT 1.22. Photon plans greater volumes of normal tissue at 10-95% isodose Conclusion: Carbon ion has potential to improve target dose conformity, inhomogeneity and OAR sparing 2004 (1994-1997) 15380567 -- "Dose escalation study of carbon ion radiotherapy for locally advanced head-and-neck cancer." (Mizoe JE, Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):358-64.) Phase I/II. 36 patients, locally advanced H&N. Group A: 18 fractions (48.6/18 GyE to 70.2/18 GyE). Group B: 16 fractions (52.8/16 to 64/16). Endpoint erythema and mucositis. Median F/U 7.5 years Outcome: MTD 70.2/18 (1/2 patients Grade 3 acute toxicity) and 64/16 (2/3 patients Grade 3 acute toxicity). 5-year LC 75%, better with non-squamous tumors including adenoid cystic and melanoma Conclusoin: Carbon ion will deliver high local control without unacceptable toxicity Lawrence Berkeley Laboratory 1994 (1977-1992) 8040010 -- "Experience in charged particle irradiation of tumors of the skull base: 1977-1992." (Castro JR, Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):647-55.) Retrospective. 233 patients treated with charged particles. Tumors arising/extending to skull base. Arising: Chordoma 24%, chondrosarcoma 12%, meningioma 12%, other 9%; Extending: salivary glands 20%, nasopharynx 14%, paranasal sinuses 10%. Mean dose 65 GyE. Median F/U 4.2 years Outcome: 5-year LC meningioma 85%, chondrosarcoma 78%, chordoma 63% Conclusion: Charged particle therapy effective in controlling skull base lesions 1988 3350726 -- "Charged particle radiotherapy of selected tumors in the head and neck." (Castro JR, Int J Radiat Oncol Biol Phys. 1988 Apr;14(4):711-20.) Retrospective. 98 patients, H&N. Mean F/U 3 years Outcome: 2-year LC non-squamous 60%, squamous 35%