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

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

doi:10.14338/IJPT-20-00065.1

International Journal of Particle Therapy (Jun 2021)

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

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

Affiliations

G. Brandon Gunn, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Adam S. Garden, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Rong Ye, MSc: 2 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Noveen Ausat, BA: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Kristina R. Dahlstrom, PhD: 3 Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
William H. Morrison, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
C. David Fuller, MD, PhD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jack Phan, MD, PhD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jay P. Reddy, MD, PhD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Shalin J. Shah, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Lauren L. Mayo, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Stephen G. Chun, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Gregory M. Chronowski, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Amy C. Moreno, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jeffery N. Myers, MD, PhD: 3 Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Ehab Y. Hanna, MD: 3 Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Bita Esmaeli, MD: 4 Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Maura L. Gillison, MD, PhD: 5 Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Renata Ferrarotto, MD: 5 Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Katherine A. Hutcheson, PhD: 3 Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Mark S. Chambers, DMD, MS: 3 Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Lawrence E. Ginsberg, MD: 6 Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Adel K. El-Naggar, MD, PhD: 7 Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
David I. Rosenthal, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Xiaorong Ronald Zhu, PhD: 8 Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
Steven J. Frank, MD: 1 Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

DOI: https://doi.org/10.14338/IJPT-20-00065.1
Journal volume & issue: Vol. 8, no. 1
pp. 108 – 118

Abstract

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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.

Published in International Journal of Particle Therapy

ISSN: 2331-5180 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Science: Physics: Nuclear and particle physics. Atomic energy. Radioactivity
Website: https://www.sciencedirect.com/journal/international-journal-of-particle-therapy

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