TY - JOUR

T1 - Reduced radiation-induced toxicity by using proton therapy for the treatment of oropharyngeal cancer

AU - Meijer, Tineke W H

AU - Scandurra, Dan

AU - Langendijk, Johannes A

PY - 2020

Y1 - 2020

N2 - Patients with squamous cell carcinoma of the oropharynx are generally treated with (chemo) radiation. Patients with oropharyngeal cancer have better survival than patients with squamous cell carcinoma of other head and neck subsites, especially when related to human papillomavirus. However, radiotherapy results in a substantial percentage of survivors suffering from significant treatment-related side-effects. Late radiation-induced side-effects are mostly irreversible and may even be progressive, and particularly xerostomia and dysphagia affect health-related quality of life. As the risk of radiation-induced side-effects highly depends on dose to healthy normal tissues, prevention of radiation-induced xerostomia and dysphagia and subsequent improvement of health-relatedquality of life can be obtained by applying proton therapy, which offers the opportunity to reduce the dose to both the salivary glands and anatomic structures involved in swallowing.This review describes the results of the first cohort studies demonstrating that proton therapy results in lower dose levels in multiple organs at risk, which translates into reduced acute toxicity (i.e. up to 3 months after radiotherapy), while preserving tumour control. Next to reducing mucositis, tube feeding, xerostomia and distortion of the sense of taste, protons can improve general well-being by decreasing fatigue and nausea. Proton therapy results in decreased rates of tube feeding dependency and severe weight loss up to 1 year after radiotherapy, and may decrease the risk of radionecrosis of the mandible. Also, the model-based approach for selecting patients for proton therapy in the Netherlands is described in this review and future perspectives are discussed.

AB - Patients with squamous cell carcinoma of the oropharynx are generally treated with (chemo) radiation. Patients with oropharyngeal cancer have better survival than patients with squamous cell carcinoma of other head and neck subsites, especially when related to human papillomavirus. However, radiotherapy results in a substantial percentage of survivors suffering from significant treatment-related side-effects. Late radiation-induced side-effects are mostly irreversible and may even be progressive, and particularly xerostomia and dysphagia affect health-related quality of life. As the risk of radiation-induced side-effects highly depends on dose to healthy normal tissues, prevention of radiation-induced xerostomia and dysphagia and subsequent improvement of health-relatedquality of life can be obtained by applying proton therapy, which offers the opportunity to reduce the dose to both the salivary glands and anatomic structures involved in swallowing.This review describes the results of the first cohort studies demonstrating that proton therapy results in lower dose levels in multiple organs at risk, which translates into reduced acute toxicity (i.e. up to 3 months after radiotherapy), while preserving tumour control. Next to reducing mucositis, tube feeding, xerostomia and distortion of the sense of taste, protons can improve general well-being by decreasing fatigue and nausea. Proton therapy results in decreased rates of tube feeding dependency and severe weight loss up to 1 year after radiotherapy, and may decrease the risk of radionecrosis of the mandible. Also, the model-based approach for selecting patients for proton therapy in the Netherlands is described in this review and future perspectives are discussed.

KW - Aged

KW - Carcinoma, Squamous Cell/radiotherapy

KW - Deglutition Disorders/etiology

KW - Enteral Nutrition/statistics & numerical data

KW - Humans

KW - Mandible/radiation effects

KW - Middle Aged

KW - Netherlands

KW - Organs at Risk/radiation effects

KW - Oropharyngeal Neoplasms/radiotherapy

KW - Proton Therapy/methods

KW - Quality of Life

KW - Radiation Injuries/prevention & control

KW - Salivary Glands/radiation effects

KW - Xerostomia/etiology

KW - INTENSITY-MODULATED

KW - QUALITY-OF-LIFE

KW - PHOTON THERAPY

KW - NECK

KW - HEAD

KW - RADIOTHERAPY

KW - IMPACT

KW - MODEL

KW - IMRT

U2 - 10.1259/bjr.20190955

DO - 10.1259/bjr.20190955

M3 - Review article

C2 - 31971818

VL - 93

SP - 20190955

JO - British journal of radiology

JF - British journal of radiology

SN - 0007-1285

IS - 1107

ER -