Low contralateral failure rate with unilateral proton beam radiotherapy for oropharyngeal squamous cell carcinoma: A multi-institutional prospective study from the proton collaborative group

•PBT is associated with decreased radiation dose to the contralateral neck.•PBT contralateral neck failure rate was comparable to photon irradiation.•Subgroup analysis demonstrates comparable control rates in de novo and recurrent subgroups. Unilateral radiation therapy is appropriate for select pat...

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Published in:Radiotherapy and oncology 2024-01, Vol.190, p.109977, Article 109977
Main Authors: Mumaw, Derek A, Hazy, Allison J, Vayntraub, Aleksander, Quinn, Thomas J, Salari, Kamran, Chang, John H, Kalman, Noah, Katz, Sanford, Urbanic, James, Press, Robert H, Thukral, Arpi D, Tsai, Henry, Laramore, George E, Molitoris, Jason, Vargas, Carlos, Patel, Samir H, Stevens, Craig, Deraniyagala, Rohan L
Format: Article
Language:English
Subjects:
Carcinoma, Squamous Cell - pathology
Head and neck cancer
Head and Neck Neoplasms - etiology
Humans
Oropharyngeal cancer
Prospective Studies
Proton Therapy
Proton Therapy - adverse effects
Protons
Radiotherapy Dosage
Squamous Cell Carcinoma of Head and Neck - etiology
Unilateral
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Summary:•PBT is associated with decreased radiation dose to the contralateral neck.•PBT contralateral neck failure rate was comparable to photon irradiation.•Subgroup analysis demonstrates comparable control rates in de novo and recurrent subgroups. Unilateral radiation therapy is appropriate for select patients with oropharyngeal squamous cell carcinoma (OPSCC). The use of proton beam therapy (PBT) in the unilateral setting decreases the dose to the contralateral neck and organs at risk. This study aims to evaluate contralateral recurrences in patients who received ipsilateral PBT. We evaluated the Proton Collaborative Group database for patients treated with PBT for head and neck squamous cell carcinoma between the years 2015–2020 at 12 institutions. Dosimetric analysis was performed in five cases. Our analysis included 41 patients that received ipsilateral PBT with a mean follow-up of 14.7 months. 37% patients (n = 15) were treated for recurrent disease, and 63% (n = 26) were treated for de novo disease. Oropharyngeal sites included tonsillar fossa (n = 30) and base of tongue (n = 11). The median dose and BED delivered were 69.96 CGE and 84 Gy, respectively. Eight (20%) patients experienced at least one grade 3 dysphagia (n = 4) or esophagitis (n = 4) toxicity. No grade ≥ 4 toxicities were reported. There was one (2.4%) failure in the contralateral neck. The 1-year locoregional control was 88.9% and the freedom from distant metastasis was 95.5% (n = 2). The dosimetric analysis demonstrated similar ipsilateral level II cervical nodal region doses, whereas contralateral doses were higher with photon plans, mean: 15.5 Gy and 0.7CGE, D5%: 25.1 Gy and 6.6CGE. Our series is the first to report outcomes for patients with OPSCC receiving unilateral PBT. The contralateral neck failure rate was excellent and comparable to failure rates with photon irradiation.
ISSN:0167-8140
1879-0887
1879-0887
DOI:10.1016/j.radonc.2023.109977