title: Reduced acute toxicity and improved efficacy from intensity-modulated proton therapy (IMPT) for the management of head and neck cancer.
abstract: Cancers in the head and neck area are usually close to several critical organ structures. Traditional external-beam photon radiation therapy unavoidably exposes these structures to significant doses of radiation, which can lead to serious acute and chronic toxicity. Intensity-modulated proton therapy (IMPT), however, has dosimetric advantages that allow it to deposit high doses within the target while largely sparing surrounding structures. Because of this advantage, IMPT has the potential to improve both tumor control and toxicity. To determine the degree to which IMPT can reduce toxicity and improve tumor control, more randomized trials are needed that directly compare IMPT with intensity-modulated photon therapy. Here we examine the existing evidence on the efficacy and toxicity of IMPT for treating cancers at several anatomic subsites of the head and neck. We also report on the ability of IMPT to reduce malnutrition, and gastrostomy tube dependence and improve patient-reported outcomes (PROs).
authors: UT Southwestern Medical School, Dallas, Texas, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Matthew R
authors: MR
authors: McKeever
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA.
authors: Terence T
authors: TT
authors: Sio
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: G Brandon
authors: GB
authors: Gunn
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Emma B
authors: EB
authors: Holliday
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Pierre
authors: P
authors: Blanchard
authors: Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Merrill S
authors: MS
authors: Kies
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Randal S
authors: RS
authors: Weber
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. sjfrank@mdanderson.org.
authors: Steven J
authors: SJ
authors: Frank
mesh_terms: D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D061766:Proton Therapy / Q000379:methods*
keywords: Proton therapy; gastrostomy tube; intensity-modulated proton therapy (IMPT); malnutrition; nasopharynx cancer; oropharynx cancer