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

Br J Radiol. 2020 Mar;93(1107):20190955. doi: 10.1259/bjr.20190955. Epub 2020 Jan 30.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell / radiotherapy*
  • Deglutition Disorders / etiology
  • Deglutition Disorders / prevention & control*
  • Enteral Nutrition / statistics & numerical data
  • Humans
  • Mandible / radiation effects
  • Middle Aged
  • Netherlands
  • Organs at Risk / radiation effects
  • Oropharyngeal Neoplasms / radiotherapy*
  • Proton Therapy / methods*
  • Quality of Life
  • Radiation Injuries / prevention & control*
  • Salivary Glands / radiation effects
  • Xerostomia / etiology
  • Xerostomia / prevention & control*