Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Curr Treat Options Oncol. 2021 Jun 4;22(6):54. doi: 10.1007/s11864-021-00847-y.
The rise in the incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC), the relatively young age at which it is diagnosed, and its favorable prognosis necessitate the use of treatment techniques that reduce the likelihood of side effects during and after curative treatment. Intensity-modulated proton therapy (IMPT) is a form of radiotherapy that de-intensifies treatment through dose de-escalation to normal tissues without compromising dose to the primary tumor and involved, regional lymph nodes. Preclinical studies have demonstrated that HPV-positive squamous cell carcinoma is more sensitive to proton radiation than is HPV-negative squamous cell carcinoma. Retrospective studies comparing intensity-modulated photon (X-ray) radiotherapy to IMPT for OPC suggest comparable rates of disease control and lower rates of pain, xerostomia, dysphagia, dysgeusia, gastrostomy tube dependence, and osteoradionecrosis with IMPT-all of which meaningfully affect the quality of life of patients treated for HPV-associated OPC. Two phase III trials currently underway-the "Randomized Trial of IMPT versus IMRT for the Treatment of Oropharyngeal Cancer of the Head and Neck" and the "TOxicity Reduction using Proton bEam therapy for Oropharyngeal cancer (TORPEdO)" trial-are expected to provide prospective, level I evidence regarding the effectiveness of IMPT for such patients.
人乳头瘤病毒（HPV）相关口咽鳞状细胞癌（OPC）发病率的上升、其诊断时的相对年轻化以及良好的预后，都需要采用能够降低根治性治疗过程中和治疗后的不良反应发生概率的治疗技术。调强质子治疗（IMPT）是一种放射治疗形式，它通过对正常组织进行剂量下调来减轻治疗强度，同时又不影响肿瘤原发灶和受累的区域淋巴结的剂量。临床前研究表明，HPV 阳性鳞状细胞癌对质子辐射比 HPV 阴性鳞状细胞癌更敏感。比较 OPC 调强光子（X 射线）放疗与 IMPT 的回顾性研究表明，IMPT 的疾病控制率相当，而疼痛、口干、吞咽困难、味觉障碍、胃造口管依赖和放射性骨坏死的发生率较低——所有这些都对接受 HPV 相关 OPC 治疗的患者的生活质量产生了有意义的影响。目前正在进行两项 III 期临床试验——“头颈部癌调强质子治疗与调强适形放疗随机对照试验”和“质子束治疗降低口咽癌毒性（TORPEdO）试验”，有望为此类患者的 IMPT 有效性提供前瞻性、一级证据。
