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Intensity Modulated Proton Therapy for Head and Neck Tumors: Gilding the Lily or Holy Grail?

  • Steven J. Frank
    Correspondence
    Reprint requests to: Dr Steven J. Frank, MD, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1422, 1400 Pressler St, Houston, TX 77030-4008. Tel: (713) 563-8489
    Affiliations
    Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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      The toxic effects associated with beam paths in intensity modulated photon radiation therapy for head and neck cancer have been well characterized (
      • Rosenthal D.I.
      • Chambers M.S.
      • Fuller C.D.
      • et al.
      Beam path toxicities to non-target structures during intensity-modulated radiation therapy for head and neck cancer.
      ). During treatment, patients commonly experience dysgeusia, dysphagia, odynophagia, mucositis, xerostomia, pain, fatigue, skin desquamation, nausea, vomiting, dehydration, and weight loss, some to the point of requiring gastrostomy (G) tubes to sustain nutrition during and after treatment. In one study, 90% of patients treated with concurrent chemoradiation for oropharyngeal tumors required such a tube during treatment, and notably, 5-year rates of overall survival and disease-free survival were reduced in patients who required a G tube for more than 2.5 months (
      • Jang J.W.
      • Parambi R.J.
      • Goldsmith T.A.
      • et al.
      Factors associated with prolonged gastrostomy tube usage in patients with oropharyngeal cancer treated with chemoradiation.
      ). Moreover, the requirement for G tubes can persist well after treatment completion; in a recent pooled multi-institutional analysis of G-tube dependence among 2315 patients with oropharyngeal tumors treated with intensity modulated radiation therapy (IMRT), at a median follow-up of 43 months, the rates of G-tube dependence were 7.0% at 1 year, 4.7% at 2 years, and 3.0% at 5 years (
      • Setton J.
      • Lee N.Y.
      • Huang S.
      • et al.
      A multi-institution pooled analysis of G-tube dependence in patients with oropharyngeal cancer treated with definitive IMRT.
      ).
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