Comparing the Oncologic Outcomes of Proton Therapy and Intensity-Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

Chia-Lun Chang¹, Kuan-Chou Lin², Wan-Ming Chen³, Ben-Chang Shia³, Szu-Yuan Wu⁴

Affiliations

¹ Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University Taipei, Taiwan.
² Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
³ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
⁴ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Management, College of Management, Fo Guang University, Yilan, Taiwan. Electronic address: szuyuanwu5399@gmail.com.

PMID: 39492511
DOI: 10.1016/j.radonc.2023.109971

Comparing the Oncologic Outcomes of Proton Therapy and Intensity-Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

Chia-Lun Chang et al. Radiother Oncol. 2023.

. 2023 Oct 28:109971.

doi: 10.1016/j.radonc.2023.109971. Online ahead of print.

Authors

Chia-Lun Chang¹, Kuan-Chou Lin², Wan-Ming Chen³, Ben-Chang Shia³, Szu-Yuan Wu⁴

Affiliations

¹ Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University Taipei, Taiwan.
² Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
³ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
⁴ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Management, College of Management, Fo Guang University, Yilan, Taiwan. Electronic address: szuyuanwu5399@gmail.com.

PMID: 39492511
DOI: 10.1016/j.radonc.2023.109971

Abstract

Purpose: To compare the oncologic outcomes between proton therapy and intensity-modulated radiation therapy (IMRT) for head and neck squamous cell carcinoma (HNSCC) patients undergoing curative radiotherapy (RT).

Experimental design: We studied HNSCC patients who underwent curative-intent RT from 2015 to 2019, comparing the oncologic outcomes of proton therapy and IMRT. Our national retrospective HNSCC cohort study involved three institutes with proton therapy and 17 institutes (medical center levels) with IMRT in Taiwan. We utilized the Taiwan Cancer Registry Database to collect medical data for this study. We classified patients into two groups based on treatment method: Group 1 received IMRT, while Group 2 received proton therapy. 3:1 propensity score matching was performed to minimize the impact of potential confounders. Cox proportional hazards models were used to evaluate oncologic outcomes.

Results: This study of 60,485 patients with HNSCC found that proton therapy was associated with better overall and cancer-specific survival and lower locoregional recurrence rates than IMRT. After matching, 982 patients were analyzed, with well-balanced factors. Proton therapy was a significant predictor of all-cause mortality, cancer-specific death, and locoregional recurrence (LRR). Patients who received proton therapy had significantly lower risks of all-cause mortality (adjusted hazard ratio, aHR=0.43), cancer-specific death (aHR=0.44), and LRR (aHR=0.61) than those who received IMRT.

Conclusion: Proton therapy is associated with superior outcomes in terms of overall survival, cancer-specific survival, and locoregional recurrence rates compared to IMRT in patients with HNSCC. These results provide valuable evidence for clinicians and patients in decision-making regarding the choice of radiation therapy for HNSCC.

Keywords: HNSCC; IMRT; Proton Therapy; metastasis; recurrence; survival.

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Comparing the Oncologic Outcomes of Proton Therapy and Intensity-Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

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Comparing the Oncologic Outcomes of Proton Therapy and Intensity-Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

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