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. 2023 Jul 19;18(1):121.
doi: 10.1186/s13014-023-02317-1.

Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit

Sapna Nangia  1 , Utpal Gaikwad  2 , M P Noufal  3 , Mayur Sawant  4 , Manoj Wakde  2 , Ashwathy Mathew  2 , Srinivas Chilukuri  2 , Dayananda Sharma  3 , Rakesh Jalali  2
Affiliations

Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit

Sapna Nangia et al. Radiat Oncol. .

Abstract

Introduction: Radiation-induced oral mucositis (RIOM), is a common, debilitating, acute side effect of radiotherapy for oral cavity (OC) and oropharyngeal (OPx) cancers; technical innovations for reducing it are seldom discussed. Intensity-modulated-proton-therapy (IMPT) has been reported extensively for treating OPx cancers, and less frequently for OC cancers. We aim to quantify the reduction in the likelihood of RIOM in treating these 2 subsites with IMPT compared to Helical Tomotherapy.

Material and methods: We report acute toxicities and early outcomes of 22 consecutive patients with OC and OPx cancers treated with IMPT, and compare the dosimetry and normal tissue complication probability (NTCP) of ≥ grade 3 mucositis for IMPT and HT.

Results: Twenty two patients, 77% males, 41% elderly and 73% OC subsite, were reviewed. With comparable target coverage, IMPT significantly reduced the mean dose and D32, D39, D45, and D50, for both the oral mucosa (OM) and spared oral mucosa (sOM). With IMPT, there was a 7% absolute and 16.5% relative reduction in NTCP for grade 3 mucositis for OM, compared to HT. IMPT further reduced NTCP for sOM, and the benefit was maintained in OC, OPx subsites and elderly subgroup. Acute toxicities, grade III dermatitis and mucositis, were noted in 50% and 45.5% patients, respectively, while 22.7% patients had grade 3 dysphagia. Compared with published data, the hospital admission rate, median weight loss, feeding tube insertion, unplanned treatment gaps were lower with IMPT. At a median follow-up of 15 months, 81.8% were alive; 72.7%, alive without disease and 9%, alive with disease.

Conclusion: The dosimetric benefit of IMPT translates into NTCP reduction for grade 3 mucositis compared to Helical Tomotherapy for OPx and OC cancers and encourages the use of IMPT in their management.

Keywords: Mucositis; NTCP; Oral cavity; Oropharyngeal; Proton.

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Conflict of interest statement

The authors declares that they have no competing interests.

Figures

Fig. 1
Fig. 1
Dosimetric comparison of IMPT and HT. A—For Oral mucosa (OM). B—For spared oral mucosa (sOM). C—Percentage benefit of IMPT over HT for OM and sOM
Fig. 2
Fig. 2
NTCP of mucositis comparison. A—NTCP of mucositis for OM, sOM with HT and IMPT, respectively, with the median value for each. B—NTCP of mucositis for OM in various subgroups; a—ipsilateral radiation, b—bilateral radiation, c—elderly, d—oral cavity, f—oropharyngeal with  the median value for each
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