Youssef Irini, Yoon Jennifer, Mohamed Nader, Zakeri Kaveh, Press Robert H, Yu Yao, Kang Jung Julie, Wong Richard J, Tuttle R Michael, Shaha Ashok, Sherman Eric, Lee Nancy Y
Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Int J Part Ther. 2022 Jul 15;9(2):20-30. doi: 10.14338/IJPT-22-00005.1. eCollection 2022 Fall.
Proton therapy is an emerging therapy for several malignancies owing to its favorable therapeutic ratio. There are very limited data on the use of proton therapy in the management of thyroid carcinoma. Our objective was to review the safety, feasibility, and outcomes of proton therapy for patients with thyroid cancer treated to the head and neck.
From our institution's proton database from 2012 to 2021, we identified 22 patients with thyroid cancer treated with proton beam therapy. We evaluated outcomes and toxicities.
Median follow-up was 26 months. Of the 22 patients, 50% were female. The mean age was 65 years. Three patients had anaplastic cancer; 13, papillary carcinoma; 2, follicular carcinoma; and 2, poorly differentiated carcinoma. Forty-six percent had T4 disease. Primary targets were the central neck compartment, level VI, and upper mediastinum. Radiation dose was 60 GyRBE adjuvantly, and 70 GyRBE for gross disease (range, 6000-7600 GyRBE). Eight patients underwent upfront adjuvant radiation, and 3 received definitive radiation for unresectable disease upfront. Eleven patients received either salvage or palliative radiation. Fifty-nine percent of patients had extrathyroidal extension, and 64% of patients had gross disease in the neck before treatment. Fifty percent of patients had metastatic disease before treatment. Sixteen patients received concurrent chemotherapy, 63% of these patients received doxorubicin. For all patients, 1-year local regional recurrence (LRR) was 0%, and overall survival (OS) was 90%. Acute grade 3+ toxicities occurred in 27% of patients, the most frequent being dermatitis (27%). Three patients required a percutaneous endoscopic gastrostomy tube after radiation therapy (RT), 2 owing to progression. There were no grade 4+ toxicities.
Proton therapy for thyroid cancer appears feasible and effective with minimal toxicities. Prospective studies comparing proton therapy with intensity-modulated RT, to evaluate the clinical efficacy of using proton therapy to reduce toxicities in patients undergoing radiation for thyroid cancer, are warranted.
由于质子治疗具有良好的治疗比，它已成为几种恶性肿瘤的新兴治疗方法。关于质子治疗在甲状腺癌治疗中的应用数据非常有限。我们的目的是回顾质子治疗对接受头颈部治疗的甲状腺癌患者的安全性、可行性和治疗结果。
从我们机构2012年至2021年的质子数据库中，我们确定了22例接受质子束治疗的甲状腺癌患者。我们评估了治疗结果和毒性。
中位随访时间为26个月。22例患者中，50%为女性。平均年龄为65岁。3例为未分化癌；13例为乳头状癌；2例为滤泡状癌；2例为低分化癌。46%的患者患有T4期疾病。主要靶区为中央颈部区域、Ⅵ区和上纵隔。辅助放疗剂量为60 GyRBE，对大体肿瘤为70 GyRBE（范围为6000 - 7600 GyRBE）。8例患者接受了 upfront 辅助放疗，3例因疾病不可切除接受了根治性放疗。11例患者接受了挽救性或姑息性放疗。59%的患者有甲状腺外侵犯，64%的患者在治疗前颈部有大体肿瘤。50%的患者在治疗前有转移性疾病。16例患者接受了同步化疗，其中63%的患者接受了阿霉素治疗。所有患者的1年局部区域复发率（LRR）为0%，总生存率（OS）为90%。27%的患者发生了3级及以上急性毒性反应，最常见的是皮炎（27%）。3例患者在放疗后需要经皮内镜胃造瘘管，2例是由于病情进展。没有4级及以上毒性反应。
质子治疗甲状腺癌似乎可行且有效，毒性最小。有必要进行前瞻性研究，将质子治疗与调强放疗进行比较，以评估使用质子治疗降低甲状腺癌放疗患者毒性的临床疗效。
