Toxicity profiles and survival outcomes among patients with nonmetastatic oropharyngeal carcinoma treated with intensity-modulated proton therapy vs intensity-modulated radiation therapy Journal Article
| Authors: | Youssef, I.; Yoon, J.; Mohamed, N.; Zakeri, K.; Press, R. H.; Chen, L.; Gelblum, D. Y.; McBride, S. M.; Tsai, C. J.; Riaz, N.; Yu, Y.; Cohen, M. A.; Dunn, L. A.; Ho, A. L.; Wong, R. J.; Michel, L. S.; Boyle, J. O.; Singh, B.; Kriplani, A.; Ganly, I.; Sherman, E. J.; Pfister, D. G.; Fetten, J.; Lee, N. Y. |
| Article Title: | Toxicity profiles and survival outcomes among patients with nonmetastatic oropharyngeal carcinoma treated with intensity-modulated proton therapy vs intensity-modulated radiation therapy |
| Abstract: | Importance: Patients with oropharyngeal carcinoma (OPC) treated with radiotherapy often experience substantial toxic effects, even with modern techniques such as intensity-modulated radiation therapy (IMRT). Intensity-modulated proton therapy (IMPT) has a potential advantage over IMRT due to reduced dose to the surrounding organs at risk; however, data are scarce given the limited availability and use of IMPT. Objective: To compare toxic effects and oncologic outcomes among patients with newly diagnosed nonmetastatic OPC treated with IMPT vs IMRT with or without chemotherapy. Design, Setting, and Participants: This retrospective cohort study included patients aged 18 years or older with newly diagnosed nonmetastatic OPC who received curative-intent radiotherapy with IMPT or IMRT at a single-institution tertiary academic cancer center from January 1, 2018, to December 31, 2021, with follow-up through December 31, 2021. Exposures: IMPT or IMRT with or without chemotherapy. Main Outcomes and Measures: The main outcomes were the incidence of acute and chronic (present after ≥6 months) treatment-related adverse events (AEs) and oncologic outcomes, including locoregional recurrence (LRR), progression-free survival (PFS), and overall survival (OS). Fisher exact tests and χ2 tests were used to evaluate associations between toxic effects and treatment modality (IMPT vs IMRT), and the Kaplan-Meier method was used to compare LRR, PFS, and OS between the 2 groups. Results: The study included 292 patients with OPC (272 [93%] with human papillomavirus [HPV]-p16-positive tumors); 254 (87%) were men, 38 (13%) were women, and the median age was 64 years (IQR, 58-71 years). Fifty-eight patients (20%) were treated with IMPT, and 234 (80%) were treated with IMRT. Median follow-up was 26 months (IQR, 17-36 months). Most patients (283 [97%]) received a dose to the primary tumor of 70 Gy. Fifty-seven of the patients treated with IMPT (98%) and 215 of those treated with IMRT (92%) had HPV-p16-positive disease. There were no significant differences in 3-year OS (97% IMPT vs 91% IMRT; P = .18), PFS (82% IMPT vs 85% IMRT; P = .62), or LRR (5% IMPT vs 4% IMRT; P = .59). The incidence of acute toxic effects was significantly higher for IMRT compared with IMPT for oral pain of grade 2 or greater (42 [72%] IMPT vs 217 [93%] IMRT; P < .001), xerostomia of grade 2 or greater (12 [21%] IMPT vs 68 [29%] IMRT; P < .001), dysgeusia of grade 2 or greater (16 [28%] IMPT vs 134 [57%] IMRT; P < .001), grade 3 dysphagia (4 [7%] IMPT vs 29 [12%] IMRT; P < .001), mucositis of grade 3 or greater (10 [53%] IMPT vs 13 [70%] IMRT; P = .003), nausea of grade 2 or greater (0 [0%] IMPT vs 18 [8%] IMRT; P = .04), and weight loss of grade 2 or greater (22 [37%] IMPT vs 138 [59%] IMRT; P < .001). There were no significant differences in chronic toxic effects of grade 3 or greater, although there was a significant difference for chronic xerostomia of grade 2 or greater (6 IMPT [11%] vs 22 IMRT [10%]; P < .001). Four patients receiving IMRT (2%) vs 0 receiving IMPT had a percutaneous endoscopic gastrostomy tube for longer than 6 months. Conclusions and Relevance: In this study, curative-intent radiotherapy with IMPT for nonmetastatic OPC was associated with a significantly reduced acute toxicity burden compared with IMRT, with few chronic toxic effects and favorable oncologic outcomes, including locoregional recurrence of only 5% at 2 years. Prospective randomized clinical trials comparing these 2 technologies and of patient-reported outcomes are warranted. |
| Keywords: | middle aged; retrospective studies; intensity modulated radiation therapy; prospective study; prospective studies; neoplasm recurrence, local; radiotherapy dosage; pathology; retrospective study; radiotherapy, intensity-modulated; tumor recurrence; carcinoma; xerostomia; oropharyngeal neoplasms; papillomavirus infections; adverse event; complication; oropharynx tumor; papillomavirus infection; proton therapy; procedures; humans; human; male; female |
| Journal Title: | JAMA Network Open |
| Volume: | 5 |
| Issue: | 11 |
| ISSN: | 2574-3805 |
| Publisher: | American Medical Association |
| Date Published: | 2022-11-01 |
| Start Page: | e2241538 |
| Language: | English |
| DOI: | 10.1001/jamanetworkopen.2022.41538 |
| PUBMED: | 36367724 |
| PROVIDER: | scopus |
| PMCID: | PMC9652753 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work