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. 2011;16(3):366-77.
doi: 10.1634/theoncologist.2010-0171. Epub 2011 Feb 24.

The potential benefit of radiotherapy with protons in head and neck cancer with respect to normal tissue sparing: a systematic review of literature

Tara A van de Water  1 , Hendrik P Bijl, Cornelis Schilstra, Madelon Pijls-Johannesma, Johannes A Langendijk
Affiliations

The potential benefit of radiotherapy with protons in head and neck cancer with respect to normal tissue sparing: a systematic review of literature

Tara A van de Water et al. Oncologist. 2011.

Abstract

Purpose: Clinical studies concerning head and neck cancer patients treated with protons reporting on radiation-induced side effects are scarce. Therefore, we reviewed the literature regarding the potential benefits of protons compared with the currently used photons in terms of lower doses to normal tissue and the potential for fewer subsequent radiation-induced side effects, with the main focus on in silico planning comparative (ISPC) studies.

Materials and methods: A literature search was performed by two independent researchers on ISPC studies that included proton-based and photon-based irradiation techniques.

Results: Initially, 877 papers were retrieved and 14 relevant and eligible ISPC studies were identified and included in this review. Four studies included paranasal sinus cancer cases, three included nasopharyngeal cancer cases, and seven included oropharyngeal, hypopharyngeal, and/or laryngeal cancer cases. Seven studies compared the most sophisticated photon and proton techniques: intensity-modulated photon therapy versus intensity-modulated proton therapy (IMPT). Four studies compared different proton techniques. All studies showed that protons had a lower normal tissue dose, while keeping similar or better target coverage. Two studies found that these lower doses theoretically translated into a significantly lower incidence of salivary dysfunction.

Conclusion: The results of ISPC studies indicate that protons have the potential for a significantly lower normal tissue dose, while keeping similar or better target coverage. Scanned IMPT probably offers the most advantage and will allow for a substantially lower probability of radiation-induced side effects. The results of these ISPC studies should be confirmed in properly designed clinical trials.

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Conflict of interest statement

Disclosures: Tara A. van de Water: None; Hendrik P. Bijl: None; Cornelis Schilstra: None; Madelon Pijls-Johannesma: None; Johannes A. Langendijk: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

Figures

Figure 1.
Figure 1.
Example of a possible normal tissue complication probability (NTCP) model with the risk of a given complication (NTCP in %) as a function of radiation dose (in this case the mean dose). NTCP models can be used to estimate the risk for a certain complication as a function of dose and thus also to translate differences in dose into differences in the risk for side effects. In this example, the lower dose that can be obtained with the new technique (−10 Gy) translates into a −42% lower risk. Note that in the case of a dose reduction from 30 to 20 Gy, the benefit in terms of the risk reduction will be much less.
Figure 2.
Figure 2.
Papers retrieved from the literature search.
See this image and copyright information in PMC

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