Highlights
- •Compared to VMAT, IMPT is associated with less PEG placement for the treatment of OPC.
- •IMPT is associated with decreased acute hospitalizations compared to VMAT.
- •Provider-reported acute toxicities show less mucositis, dysphagia, and pain with IMPT.
- •Patient-reported outcomes improved with IMPT included cough and dysgeusia.
- •Benefits were predominantly seen in those treated definitively or with adjuvant CRT.
Abstract
Background and purpose
IMPT improves normal tissue sparing compared to VMAT in treating oropharyngeal cancer
(OPC). Our aim was to assess if this translates into clinical benefits.
Materials and methods
OPC patients treated with definitive or adjuvant IMPT or VMAT from 2013 to 2018 were
included. All underwent prospective assessment using patient-reported-outcomes (PROs)
(EORTC-QLQ-H&N35) and provider-assessed toxicities (CTCAEv4.03). End-of-treatment
and pretreatment scores were compared. PEG-tube use, hospitalization, and narcotic
use were retrospectively collected. Statistical analysis used the Wilcoxon Rank-Sum
Test with propensity matching for PROs/provider-assessed toxicities, and t-tests for other clinical outcomes.
Results
46 IMPT and 259 VMAT patients were included; median follow-up was 12 months (IMPT)
and 30 months (VMAT). Baseline characteristics were balanced except for age (p = 0.04, IMPT were older) and smoking (p < 0.01, 10.9% IMPT >20PYs, 29.3% VMAT). IMPT was associated with lower PEG placement
(OR = 0.27; 95% CI: 0.12–0.59; p = 0.001) and less hospitalization ≤60 days post-RT (OR = 0.21; 95% CI:0.07–0.6, p < 0.001), with subgroup analysis revealing strongest benefits in patients treated
definitively or with concomitant chemoradiotherapy (CRT). IMPT was associated with
a relative risk reduction of 22.3% for end-of-treatment narcotic use. Patients reported
reduced cough and dysgeusia with IMPT (p < 0.05); patients treated definitively or with CRT also reported feeling less ill,
reduced feeding tube use, and better swallow. Provider-assessed toxicities demonstrated
less pain and mucositis with IMPT, but more mucosal infection.
Conclusion
IMPT is associated with improved PROs, reduced PEG-tube placement, hospitalization,
and narcotic requirements. Mucositis, dysphagia, and pain were decreased with IMPT.
Benefits were predominantly seen in patients treated definitively or with CRT.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Radiotherapy and OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Human papillomavirus and survival of patients with oropharyngeal cancer.N Engl J Med. 2010; 363: 24-35
- Epidemiology of human papillomavirus-positive head and neck squamous cell carcinoma.J Clin Oncol. 2015; 33: 3235-3242
- Phase 2 trial of de-intensified chemoradiation therapy for favorable-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma.Int J Radiat Oncol Biol Phys. 2015; 93: 976-985
- Patterns of disease recurrence following treatment of oropharyngeal cancer with intensity modulated radiation therapy.Int J Radiat Oncol Biol Phys. 2013; 85: 941-947
- Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial.Lancet. 2019; 393: 40-50
- Radiation therapy for head and neck cancers.Semin Oncol Nurs. 2009; 25: 193-202
- Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer.Arch Otolaryngol Head Neck Surg. 2009; 135: 1209-1217
- Enteral feeding tubes in patients undergoing definitive chemoradiation therapy for head-and-neck cancer: a critical review.Int J Radiat Oncol Biol Phys. 2012; 84: 581-589
- Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy.J Clin Oncol. 2008; 26: 3770-3776
- Proton radiation therapy for head and neck cancer: a review of the clinical experience to date.Int J Radiat Oncol Biol Phys. 2014; 89: 292-302
- Proton therapy for head and neck cancer.Curr Opin Oncol. 2015; 27: 165-171
- Treatment de-escalation for HPV-driven oropharyngeal cancer: Where do we stand?.Clin Transl Radiat Oncol. 2018; 8: 4-11
- Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: a case-matched control analysis.Med Dosim. 2016; 41: 189-194
- Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation.Radiother Oncol. 2016; 118: 286-292
- Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer.Radiother Oncol. 2017; 123: 401-405
- Intensity-modulated proton beam therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for patients with oropharynx cancer – a case matched analysis.Radiother Oncol. 2016; 120: 48-55
- Intensity modulated proton therapy versus intensity modulated photon radiation therapy for oropharyngeal cancer: first comparative results of patient-reported outcomes.Int J Radiat Oncol Biol Phys. 2016; 95: 1107-1114
- Comparing intensity-modulated proton therapy with intensity-modulated photon therapy for oropharyngeal cancer: the journey from clinical trial concept to activation.Semin Radiat Oncol. 2018; 28: 108-113
- Early experience with IMPT for the treatment of oropharyngeal tumors: acute toxicities and swallowing-related outcomes.Int J Radiat Oncol Biol Phys. 2013; 87: S604
- Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?.Cancer. 2001; 91: 1785-1790
- Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation.Head Neck. 2009; 31: 867-876
- Clinical predictors of quality of life in patients with head and neck cancer.Arch Otolaryngol Head Neck Surg. 2004; 130: 401-408
- Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer.Int J Radiat Oncol Biol Phys. 2002; 53: 23-28
- Association between severity of dysphagia and survival in patients with head and neck cancer.Head Neck. 2012; 34: 776-784
- Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: a systematic review of literature.Radiother Oncol. 2018; 126: 56-67
- Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer.J Clin Oncol. 2006; 24: 2636-2643
- Protons in head-and-neck cancer: bridging the gap of evidence.Int J Radiat Oncol Biol Phys. 2013; 85: 1282-1288
- The use of proton therapy in the treatment of head and neck cancers.Cancer J. 2014; 20: 421-426
- Impact of age on patient-reported outcome measures in total knee arthroplasty.J Knee Surg. 2018; 31: 580-584
Article info
Publication history
Published online: March 29, 2020
Accepted:
March 6,
2020
Received in revised form:
February 12,
2020
Received:
October 18,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
