Aljabab Saif, Liu Andrew, Wong Tony, Liao Jay J, Laramore George E, Parvathaneni Upendra
Department of Radiation Oncology, Roswell Park Cancer Center, Buffalo, NY, USA.
Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, USA.
Int J Part Ther. 2020 Winter;6(3):1-12. doi: 10.14338/IJPT-19-00053.1. Epub 2019 Dec 19.
Proton therapy can potentially improve the therapeutic ratio over conventional radiation therapy for oropharyngeal squamous cell cancer (OPSCC) by decreasing acute and late toxicity. We report our early clinical experience with intensity-modulated proton therapy (IMPT).
We retrospectively reviewed patients with OPSCC treated with IMPT at our center. Endpoints include local regional control (LRC), progression-free survival (PFS), overall survival (OS), tumor response, and toxicity outcomes. Toxicity was graded as per the Common Terminology Criteria for Adverse Events v4.03. Descriptive statistics and Kaplan-Meier method were used.
We treated 46 patients from March 2015 to August 2017. Median age was 58 years, 93.5% were male, 67% were nonsmokers, 98% had stage III-IVB disease per the 7th edition of the [American Joint Committee on Cancer] , and 89% were p16 positive. Twenty-eight patients received definitive IMPT to total dose of 70 to 74.4 Gy(RBE), and 18 patients received postoperative IMPT to 60 to 66 Gy(RBE) following transoral robotic surgery (TORS). Sixty-four percent of patients received concurrent systemic therapy. There were no treatment interruptions or observed acute grade 4 or 5 toxicities. Eighteen patients had percutaneous endoscopic gastrostomy (PEG) tube placement; the majority (14) were placed prophylactically. The most common grade 3 acute toxicities were dermatitis (76%) and mucositis (72%). The most common late toxicity was grade 2 xerostomia (30%). At a median follow-up time of 19.2 months (interquartile range [IQR], 11.2-28.4), primary complete response was 100% and nodal complete response was 92%. One patient required a salvage neck dissection owing to an incomplete response at 4 months. There were no recorded local regional or marginal recurrences, PFS was 93.5%, and OS was 95.7%.
Our early results for IMPT in OPSCC are promising with no local regional or marginal recurrences and a favorable toxicity profile. Our data add to a body of evidence that supports the clinical use of IMPT. Randomized comparative trials are encouraged.
质子治疗有可能通过降低急性和晚期毒性，提高口咽鳞状细胞癌（OPSCC）相对于传统放射治疗的治疗比。我们报告了我们在调强质子治疗（IMPT）方面的早期临床经验。
我们回顾性分析了在我们中心接受IMPT治疗的OPSCC患者。观察终点包括局部区域控制（LRC）、无进展生存期（PFS）、总生存期（OS）、肿瘤反应和毒性结果。毒性按照不良事件通用术语标准第4.03版进行分级。采用描述性统计和Kaplan-Meier方法。
2015年3月至2017年8月，我们共治疗了46例患者。中位年龄为58岁，93.5%为男性，67%为非吸烟者，根据美国癌症联合委员会第7版，98%为III-IVB期疾病，89%为p16阳性。28例患者接受了70至74.4 Gy（相对生物效应）的根治性IMPT，18例患者在经口机器人手术（TORS）后接受了60至66 Gy（相对生物效应）的术后IMPT。64%的患者接受了同步全身治疗。没有治疗中断，也未观察到急性4级或5级毒性。18例患者放置了经皮内镜胃造口术（PEG）管；大多数（14例）是预防性放置。最常见的3级急性毒性是皮炎（76%）和粘膜炎（72%）。最常见的晚期毒性是2级口干（30%）。中位随访时间为19.2个月（四分位间距[IQR]，11.2 - 28.4），原发灶完全缓解率为100%，淋巴结完全缓解率为92%。1例患者因4个月时反应不完全而需要挽救性颈部清扫术。没有记录到局部区域或边缘复发，PFS为93.5%，OS为95.7%。
我们在OPSCC中IMPT的早期结果很有前景，没有局部区域或边缘复发，且毒性特征良好。我们的数据补充了支持IMPT临床应用的证据。鼓励开展随机对照试验。
