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Comparative Study
. 2019 Oct 23;60(5):612-621.
doi: 10.1093/jrr/rrz036.

Proton therapy for non-squamous cell carcinoma of the head and neck: planning comparison and toxicity

Hiromitsu Iwata  1   2 , Toshiyuki Toshito  3 , Kensuke Hayashi  4 , Maho Yamada  5 , Chihiro Omachi  3 , Koichiro Nakajima  1   2 , Yukiko Hattori  1 , Shingo Hashimoto  1 , Yo Kuroda  6 , Yoshihide Okumura  7 , Jun-Etsu Mizoe  1   8 , Hiroyuki Ogino  1   2 , Yuta Shibamoto  2
Affiliations
Comparative Study

Proton therapy for non-squamous cell carcinoma of the head and neck: planning comparison and toxicity

Hiromitsu Iwata et al. J Radiat Res. .

Abstract

To investigate optimal treatment planning using proton beams for non-squamous cell carcinoma of the head and neck (NSCHN), the dose distributions of plans involving pencil beam scanning (PBS) with or without a patient-specific aperture system (PSAS), passive-scattering proton therapy (PSPT) and X-ray intensity-modulated radiotherapy (IMRT) were compared. As clinical results, toxicities of PBS with PSAS, including changes in quality of life, were reported. Between April 2014 and August 2016, a total of 30 patients were treated using PBS with PSAS. In 20 patients selected at random, the dose distributions of PBS with or without the PSAS, PSPT and IMRT plans were compared. Neutron exposure by proton therapy was calculated using a Monte Carlo simulation. Toxicities were scored according to CTCAE ver. 4.0. Patients completed EORTC quality of life survey forms (QLQ-C30 and QLQ-HN35) before and 0-12 months after proton therapy. The 95% conformity number of PBS with the PSAS plan was the best, and significant differences were detected among the four plans (P < 0.05, Bonferroni tests). Neutron generation by PSAS was ~1.1-fold higher, but was within an acceptable level. No grade 3 or higher acute dermatitis was observed. Pain, appetite loss and increased weight loss were more likely at the end of treatment, but recovered by the 3 month follow-up and returned to the pretreatment level at the 12 month follow-up. PBS with PSAS reduced the penumbra and improved dose conformity in the planning target volume. PBS with PSAS was tolerated well for NSCHN.

Keywords: X-ray intensity-modulated radiotherapy; non-squamous cell carcinoma of the head and neck; passive-scattering proton therapy; patient-specific aperture system; pencil beam scanning; quality of life.

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Figures

Fig. 1.
Fig. 1.
(A) In order to maintain dose coverage by the scanning irradiation method for shallow lesions, there is a limit to beam energy related to SOBP formation, and it is indispensable to use an absorber. (B) The patient-specific aperture system, range absorber and apertures. We have types 1–4, and these may be used appropriately depending on the size and depth of the irradiation field. (C) The beam exit port fit with the patient-specific aperture system.
Fig. 2.
Fig. 2.
Comparisons of treatment planning for each irradiation method. Regarding proton therapy, dose calculation to guarantee the dose on the proximal side is necessary, and the stopping power of protons in the air is estimated from the CT number of air by the VQA planning system.
Fig. 3.
Fig. 3.
(A) Neutron dose distribution. Left, pencil beam scanning (PBS) with a patient-specific aperture system (PSAS); middle, PBS without PSAS; and right, passive-scattering proton therapy (PSPT). (B) Dose equivalents (Sv) at various positions away from the irradiation position center. Red, PSPT; blue, PBS with PSAS; and green, PBS without PSAS.
See this image and copyright information in PMC

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