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Proton therapy equal to conventional therapy for head and neck cancers

CANCER DIGEST – June 9, 2024 – Patients with cancers of the head and neck achieved the same progression-free survival when treated with proton therapy compared to those treated with conventional radiation therapy, according to preliminary data presented at the ASCO 2024 annual meeting.

Steven Frank, MD, and professor of Radiation Oncology at the Particle Therapy Institute of the University of Texas MD Anderson Cancer Center told members of the American Society of Clinical Oncology that, in addition to equivalent progression-free survival, patients in the proton therapy group also experienced a significant reduction in malnutrition compared to the radiation therapy group.

Patients treated for cancers of the mouth, neck, and throat often have difficulty consuming enough nutrition through eating and often have to be put on a feeding tube while recovering from cancer treatment.

Proton therapy uses proton radiation, whereas conventional radiation therapy uses photons. Protons have mass, which allows doctors to more specifically target tumors and limit the amount of energy passing through the tumor into normal tissue. Photons used in conventional radiation have no mass, which makes it much harder to control the amount of radiation energy that hits the tumor and passes through it to damage normal tissue. 

The clinical trial involved 440 patients with head and neck cancers at 21 cancer centers in the US, with 219 receiving conventional radiation therapy, or intensity-modulated radiation therapy (IMRT), and 221 receiving proton therapy, or intensity-modulated proton therapy (IMPT). 

With a median follow-up of three years, 83 percent of the proton therapy group had their cancers stop growing after treatment, called progression-free survival. That compared to 83.5 percent of the conventional radiation therapy group. 

In addition, there was a significant reduction of malnutrition among the proton therapy group, with 24 percent of them maintaining adequate nutrition levels with less than 5 percent weight loss during treatment. That compared to 14 percent of those who maintained adequate nutrition with less than 5 percent weight loss during treatment in the radiation therapy group. Among the proton therapy group only 28 percent needed a feeding tube to maintain nutrition compared 42 percent of those in the radiation therapy group.

"The results of this multi-center Phase III radomized trial provide evidence for IMPT as a new standard-of-care treatment approach for the management of head and neck cancers," Frank said in a press release. "This is significant for patients as IMPT represents a curative, de-intensified option compared to traditional radiation therapy with IMRT."

The down side of proton therapy is the machines used to deliver proton therapy are hugely expensive costing hundreds of millions of dollars. Consequently proton therapy is available in comparatively few places in the US.

The study was funded by the National Institutes of Health and the National Cancer Institute.

Source: MD Anderson Cancer Center press release


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