Clinical Outcomes and Patterns of Disease Recurrence After Intensity Modulated Proton Therapy for Oropharyngeal Squamous Carcinoma.

Abstract

PURPOSE:

A single-institution prospective study was conducted to assess disease control and toxicity of proton therapy for patients with head and neck cancer.

METHODS AND MATERIALS:

Disease control, toxicity, functional outcomes, and patterns of failure for the initial cohort of patients with oropharyngeal squamous carcinoma (OPC) treated with intensity modulated proton therapy (IMPT) were prospectively collected in 2 registry studies at a single institution. Locoregional failures were analyzed by using deformable image registration.

RESULTS:

Fifty patients with OPC treated from March 3, 2011, to July 2014 formed the cohort. Eighty-four percent were male, 50% had never smoked, 98% had stage III/IV disease, 64% received concurrent therapy, and 35% received induction chemotherapy. Forty-four of 45 tumors (98%) tested for p16 were positive. All patients received IMPT (multifield optimization to n=46; single-field optimization to n=4). No Common Terminology Criteria for Adverse Events grade 4 or 5 toxicities were observed. The most common grade 3 toxicities were acute mucositis in 58% of patients and late dysphagia in 12%. Eleven patients had a gastrostomy (feeding) tube placed during therapy, but none had a feeding tube at last follow-up. At a median follow-up time of 29 months, 5 patients had disease recurrence: local in 1, local and regional in 1, regional in 2, and distant in 1. The 2-year actuarial overall and progression-free survival rates were 94.5% and 88.6%.

CONCLUSIONS:

The oncologic, toxicity, and functional outcomes after IMPT for OPC are encouraging and provide the basis for ongoing and future clinical studies.

• Authors: G Brandon Gunn, Pierre Blanchard, Adam S Garden, X Ronald Zhu, C David Fuller, Abdallah S Mohamed, William H Morrison, Jack Phan, Beth M Beadle, Heath D Skinner, Erich M Sturgis, Merrill S Kies, Kate A Hutcheson, David I Rosenthal, Radhe Mohan, Michael T Gillin, Steven J Frank
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 95 Issue 1 Pg. 360-367 (May 01 2016) ISSN: 1879-355X [Electronic] United States
• PMID: 27084653 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (diagnostic imaging, mortality, pathology, radiotherapy)
• Deglutition Disorders (etiology)
• Disease-Free Survival
• Female
• Humans
• Induction Chemotherapy
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Oropharyngeal Neoplasms (diagnostic imaging, mortality, pathology, radiotherapy)
• Prospective Studies
• Proton Therapy (adverse effects, methods)
• Radiation Injuries (pathology)
• Radiography
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Registries
• Stomatitis (etiology, pathology)
• Treatment Failure
• Treatment Outcome