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. 2021 Jun 25;8(1):108-118.
doi: 10.14338/IJPT-20-00065.1. eCollection 2021 Summer.

Proton Therapy for Head and Neck Cancer: A 12-Year, Single-Institution Experience

G Brandon Gunn  1 , Adam S Garden  1 , Rong Ye  2 , Noveen Ausat  1 , Kristina R Dahlstrom  3 , William H Morrison  1 , C David Fuller  1 , Jack Phan  1 , Jay P Reddy  1 , Shalin J Shah  1 , Lauren L Mayo  1 , Stephen G Chun  1 , Gregory M Chronowski  1 , Amy C Moreno  1 , Jeffery N Myers  3 , Ehab Y Hanna  3 , Bita Esmaeli  4 , Maura L Gillison  5 , Renata Ferrarotto  5 , Katherine A Hutcheson  3 , Mark S Chambers  3 , Lawrence E Ginsberg  6 , Adel K El-Naggar  7 , David I Rosenthal  1 , Xiaorong Ronald Zhu  8 , Steven J Frank  1
Affiliations

Proton Therapy for Head and Neck Cancer: A 12-Year, Single-Institution Experience

G Brandon Gunn et al. Int J Part Ther. .

Abstract

Purpose: To characterize our experience and the disease control and toxicity of proton therapy (PT) for patients with head and neck cancer (HNC).

Patients and methods: Clinical outcomes for patients with HNC treated with PT at our institution were prospectively collected in 2 institutional review board-approved prospective studies. Descriptive statistics were used to summarize patient characteristics and outcomes. Overall survival, local-regional control, and disease-free survival were estimated by the Kaplan-Meier method. Treatment-related toxicities were recorded according to the Common Terminology Criteria for Adverse Events (version 4.03) scale.

Results: The cohort consisted of 573 patients treated from February 2006 to June 2018. Median patient age was 61 years. Oropharynx (33.3%; n = 191), paranasal sinus (11%; n = 63), and periorbital tissues (11%; n = 62) were the most common primary sites. Patients with T3/T4 or recurrent disease comprised 46% (n = 262) of the cohort. The intent of PT was definitive in 53% (n = 303), postoperative in 37% (n = 211), and reirradiation in 10% (n = 59). Median dose was 66 Gy (radiobiological equivalent). Regarding systemic therapy, 43% had received concurrent (n = 244), 3% induction (n = 19), and 15% (n = 86) had both. At a median follow-up of 2.4 years, 88 patients (15%) had died and 127 (22%) developed disease recurrence. The overall survival, local-regional control, and disease-free survival at 2 and 5 years were, respectively, 87% and 75%, 87% and 78%, and 74% and 63%. Maximum toxicity (acute or late) was grade 3 in 293 patients (51%), grade 2 in 234 patients (41%), and grade 1 in 31 patients (5%). There were 381 acute grade 3 and 190 late grade 3 unique toxicities across 212 (37%) and 150 (26%) patients, respectively. There were 3 late-grade 4 events across 2 patients (0.3%), 2 (0.3%) acute-grade 5, and no (0%) late-grade 5 events.

Conclusions: The overall results from this prospective study of our initial decade of experience with PT for HNC show favorable disease control and toxicity outcomes in a multidisease-site cohort and provide a reference benchmark for future comparison and study.

Keywords: head and neck cancer; proton therapy; survival; toxicity.

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Conflict of interest statement

Conflicts of Interest: Steven J. Frank, MD, is an Associate Editor of the International Journal of Particle Therapy. Dr Frank is a scientific advisory board member of Breakthrough Chronic Care; he has received research grants from C4 Imaging, Eli Lilly, Elekta, and Hitachi, and he has reported personal fees from Varian Medical Systems, Inc (consultant/advisory board), C4 Imaging (founder and director), Hitachi (honoraria/advisory board), Augmenix (honoraria), and National Comprehensive Cancer Center (board member). Stephen G. Chun, MD, is a consultant for AstraZeneca, PLC. The authors report no other conflicts of interest.

Figures

Figure 1.
Figure 1.
Overall survival and 95% CI after proton therapy for head and neck cancer for the entire study cohort.
Figure 2.
Figure 2.
Overall survival (top), local-regional control (middle), and disease-free survival (bottom panel) after proton therapy for head and neck cancer, by treatment group.
Figure 3.
Figure 3.
Overall survival (top), local-regional control (middle), and disease-free survival (bottom) after definitive or postoperative proton therapy for the top five most commonly treated sites, by primary site.
See this image and copyright information in PMC

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