title: Treatment results of alternating chemoradiotherapy followed by proton beam therapy boost combined with intra-arterial infusion chemotherapy for stage III-IVB tongue cancer.
abstract: OBJECTIVE
  Proton beam therapy (PBT), compared with conventional radiotherapy, can deliver high-dose radiation to a tumor, while minimizing doses delivered to surrounding normal tissues. The better dose distribution of PBT may contribute to the improvement in local control rate and reduction in late adverse events. We evaluated therapeutic results and toxicities of PBT combined with selective intra-arterial infusion chemotherapy (PBT-IACT) in patients with stage III-IVB squamous cell carcinoma of the tongue.
  
  
  METHODS
  After 2 systemic chemotherapy courses and whole-neck irradiation (36 Gy in 20 fractions), we administered concurrent chemoradiotherapy comprising PBT for the primary tumor [28.6-33 Gy(RBE) in 13-15 fractions] and for the metastatic neck lymph node [33-39.6 Gy(RBE) in 15-18 fractions] with weekly retrograde intra-arterial chemotherapy by continuous infusion of cisplatin with sodium thiosulfate.
  
  
  RESULTS
  Between February 2009 and September 2012, 33 patients were enrolled. The median follow-up duration was 43 months. The 3-year overall survival, progression-free survival, local control rate, and regional control rate for the neck were 87.0, 74.1, 86.6, and 83.9 %, respectively. Major acute toxicities >grade 3 included mucositis in 26 cases (79 %), neutropenia in 17 cases (51 %), and dermatitis in 11 cases (33 %). Late grade 2 osteoradionecrosis was observed in 1 case (3 %).
  
  
  CONCLUSIONS
  PBT-IACT for stage III-IVB tongue cancer has an acceptable toxicity profile and showed good treatment results. This protocol should be considered as a treatment option for locally advanced tongue cancer.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. kanakotkym@gmail.com.|Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan. kanakotkym@gmail.com.
authors.forename: Kanako
authors.initials: K
authors.lastname: Takayama
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Takada
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
authors.forename: Chiyoko
authors.initials: C
authors.lastname: Makita
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Motohisa
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Azami
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.|Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ono
authors.affiliation: Department of Radiation Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Toyomasu
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Hareyama
authors.affiliation: Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima, 963-8052, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Division of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Mitsudo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
authors.forename: Iwai
authors.initials: I
authors.lastname: Tohnai
authors.affiliation: Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Shinguchokoto, Tatsuno, Hyogo, 679-5165, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Fuwa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D014062:Tongue Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D002945:Cisplatin
keywords: Chemoradiotherapy; Cisplatin; Intra-arterial infusion chemotherapy; Proton beam therapy; Radiotherapy; Tongue cancer