Proton Beam Therapy for Head and Neck Carcinoma of Unknown Primary: Toxicity and Quality of Life

Alexander D. Sherry, BS; Dario Pasalic, MD; G. Brandon Gunn, MD; C. David Fuller, MD, PhD; Jack Phan, MD, PhD; David I. Rosenthal, MD; William H. Morrison, MD; Erich M. Sturgis, MD; Neil D. Gross, MD; Maura L. Gillison, MD, PhD; Renata Ferrarotto, MD; Adel K. El-Naggar, MD; Adam S. Garden, MD; Frank MDSteven J.

doi:10.14338/IJPT-20-00034.1

International Journal of Particle Therapy (Jun 2021)

Proton Beam Therapy for Head and Neck Carcinoma of Unknown Primary: Toxicity and Quality of Life

Alexander D. Sherry, BS,
Dario Pasalic, MD,
G. Brandon Gunn, MD,
C. David Fuller, MD, PhD,
Jack Phan, MD, PhD,
David I. Rosenthal, MD,
William H. Morrison, MD,
Erich M. Sturgis, MD,
Neil D. Gross, MD,
Maura L. Gillison, MD, PhD,
Renata Ferrarotto, MD,
Adel K. El-Naggar, MD,
Adam S. Garden, MD,
Frank MDSteven J.

Affiliations

Alexander D. Sherry, BS: 1 Vanderbilt University School of Medicine, Nashville, TN, USA
Dario Pasalic, MD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
G. Brandon Gunn, MD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
C. David Fuller, MD, PhD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Jack Phan, MD, PhD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
David I. Rosenthal, MD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
William H. Morrison, MD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Erich M. Sturgis, MD: 3 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Neil D. Gross, MD: 3 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Maura L. Gillison, MD, PhD: 4 Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Renata Ferrarotto, MD: 4 Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Adel K. El-Naggar, MD: 5 Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Adam S. Garden, MD: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Frank MDSteven J.: 2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

DOI: https://doi.org/10.14338/IJPT-20-00034.1
Journal volume & issue: Vol. 8, no. 1
pp. 234 – 247

Abstract

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Purpose: Proton radiation therapy (PRT) may offer dosimetric and clinical benefit in the treatment of head and neck carcinoma of unknown primary (HNCUP). We sought to describe toxicity and quality of life (QOL) in patients with HNCUP treated with PRT. Patients and Methods: Toxicity and QOL were prospectively tracked in patients with HNCUP from 2011 to 2019 after institutional review board approval. Patients received PRT to the mucosa of the nasopharynx, oropharynx, and bilateral cervical lymph nodes with sparing of the larynx and hypopharynx. Patient-reported outcomes were tracked with the MD Anderson Symptom Inventory–Head and Neck Module, the Functional Assessment of Cancer Therapy–Head and Neck, the MD Anderson Dysphagia Inventory, and the Xerostomia-Related QOL Scale. Primary study endpoints were the incidence of grade ≥ 3 (G3) toxicity and QOL patterns. Results: Fourteen patients (median follow-up, 2 years) were evaluated. Most patients presented with human papillomavirus–positive disease (n = 12, 86%). Rates of G3 oral mucositis, xerostomia, and dermatitis were 7% (n = 1), 21% (n = 3), and 36% (n = 5), respectively. None required a gastrostomy. During PRT, QOL was reduced relative to baseline and recovered shortly after PRT. At 2 years after PRT, the local regional control, disease-free survival, and overall survival were 100% (among 7 patients at risk), 79% (among 6 patients at risk), and 90% (among 7 patients at risk), respectively. Conclusion: Therefore, PRT for HNCUP was associated with highly favorable dosimetric and clinical outcomes, including minimal oral mucositis, xerostomia, and dysphagia. Toxicity and QOL may be superior with PRT compared with conventional radiation therapy and PRT maintains equivalent oncologic control. Further prospective studies are needed to evaluate late effects and cost-effectiveness.

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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