Comparing Intensity-Modulated Proton Therapy With Intensity-Modulated Photon Therapy for Oropharyngeal Cancer: The Journey From Clinical Trial Concept to Activation

Intensity-modulated proton therapy minimizes the incidental irradiation of normal tissues in patients with head and neck cancer relative to intensity-modulated photon (x-ray) therapy and has been associated with lesser treatment-related toxicity and improved quality of life. A phase II/III randomized trial sponsored by the US National Cancer Institute is currently underway to compare deintensification treatment strategies with intensity-modulated proton therapy vs intensity-modulated photon (x-ray) therapy for patients with advanced-stage oropharyngeal tumors.
Source: Seminars in Radiation Oncology - Category: Cancer & Oncology Authors: Source Type: research

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Proton therapy has an important role in the management of head and neck cancer, where the dosimetric characteristics of proton particles are advantageous for treating tumors in complex anatomic areas. In addition to highly targeted dose depositions owing to the Bragg peak and superior lateral dose distribution of proton therapy, the introduction of spot-scanning techniques that allow intensity-modulated proton therapy (IMPT) further improve dose distributions and normal-tissue sparing relative to intensity-modulated (photon) radiation therapy (IMRT), a finding that has been validated in case-matched analyses showing lower ...
Source: Radiotherapy and Oncology - Category: Radiology Authors: Tags: Original Article Source Type: research
It is critical that rigorous evaluation of technology in radiation oncology be undertaken during the early stages of implementation or when there is a marked cost differential. Prospective clinical data proving the clinical effectiveness of emerging technology may not be available to guide proper investment and development. In these scenarios, models can be used to simulate expected clinical outcomes and predict comparative effectiveness and cost-effectiveness.1 In this edition of the Red Journal, 2 studies use model-based approaches to compare photon intensity modulated radiation therapy (IMRT) to proton beam therapy (PBT...
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Clinical Investigation Source Type: research
Conclusions: Pediatric patients with head and neck cancer can be risk-stratified based on clinical and dosimetric factors. This data, combined with parent and patient perceptions, is key to the development of rational guidelines.
Source: Journal of Pediatric Hematology Oncology - Category: Hematology Tags: Online Articles: Original Articles Source Type: research
CONCLUSIONS: The selection of lymph node target volumes for head and neck cancers treated with IMRT/VMAT or other highly conformal techniques (e.g. proton therapy) requires a rigorous approach. This updated proposal of selection should help clinicians for the selection of lymph nodes target volumes and contribute to increase consistency. PMID: 31005201 [PubMed - in process]
Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology - Category: Radiology Authors: Tags: Radiother Oncol Source Type: research
We developed and implemented a data-driven decision support system for identifying those oropharyngeal cancer patients likely to have the greatest benefit from proton therapy. We found that younger patients with p16-positive tumors who smoked ≤10 pack-years were estimated to have the most quality-adjusted life years (QALYs) spared with proton therapy, as compared to photon IMRT. Importantly, the estimated benefit of proton therapy depends strongly on the organ-at-risk doses achievable with photon IMRT.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Physics Contribution Source Type: research
In the modern era, favorable oncologic and survival outcomes are achieved for many patients with head and neck squamous cell carcinoma (HNSCC) treated with curative-intent radiotherapy (RT) [1 –3], particularly for those with human papilloma virus (HPV) associated disease [4,5]. Consequently, there is now substantial emphasis on reduction of late radiation toxicities for the ever increasing numbers of long-term survivors [5]. As burden of xerostomia is partially mitigated by the use of more conformal treatment techniques such as intensity modulated radiotherapy (IMRT) and proton therapy [6–8], dysphagia has ove...
Source: Radiotherapy and Oncology - Category: Radiology Authors: Tags: Original article Source Type: research
Proton therapy plays an important role in the management of head and neck cancer, where the challenging anatomy benefits from dosimetric advantages of protons. The reduction of treatment-related morbidity is significant for oropharyngeal cancer, as increasingly younger, HPV-positive patients with more favorable prognoses are treated. Patient-reported outcome (PRO) instruments such as the MD Anderson Symptom Inventory (MDASI) have described the response profile of symptoms experienced by patients.
Source: International Journal of Radiation Oncology * Biology * Physics - Category: Radiology Authors: Tags: Poster Abstract Source Type: research
Because of its sharp lateral penumbra and steep distal fall-off, proton therapy offers dosimetric advantages over photon therapy. In head and neck cancer, proton therapy has been used for decades in the treatment of skull-base tumors. In recent years the use of proton therapy has been extended to numerous other disease sites, including nasopharynx, oropharynx, nasal cavity and paranasal sinuses, periorbital tumors, skin, and salivary gland, or to reirradiation. The aim of this review is to present the physical properties and dosimetric benefit of proton therapy over advanced photon therapy; to summarize the clinical benefi...
Source: Seminars in Radiation Oncology - Category: Cancer & Oncology Authors: Source Type: research
CONCLUSIONS: Quantification of the dosimetric advantage of patient-specific bolus shows significant reductions compared to conventional RS solutions for xerostomia and dysphagia probability. These results motivate the development of a patient-specific bolus solution in IMPT for HNC. PMID: 28951008 [PubMed - as supplied by publisher]
Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology - Category: Radiology Authors: Tags: Radiother Oncol Source Type: research
ConclusionHPV‐positive cells were more sensitive to protons than HPV‐negative cells maybe through the effects of HPV on DNA damage and repair. The RBE for protons depends more on cell type and fraction size than on HPV status. © 2016 Wiley Periodicals, Inc. Head Neck, 2016
Source: Head and Neck - Category: ENT & OMF Authors: Tags: Original Article Source Type: research
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