Lillo Sara, Mirandola Alfredo, Vai Alessandro, Camarda Anna Maria, Ronchi Sara, Bonora Maria, Ingargiola Rossana, Vischioni Barbara, Orlandi Ester
Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy.
Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy.
Cancers (Basel). 2024 May 30;16(11):2085. doi: 10.3390/cancers16112085.
The growing interest in proton therapy (PT) in recent decades is justified by the evidence that protons dose distribution allows maximal dose release at the tumor depth followed by sharp distal dose fall-off. But, in the holistic management of head and neck cancer (HNC), limiting the potential of PT to a mere dosimetric advantage appears reductive. Indeed, the precise targeting of PT may help evaluate the effectiveness of de-escalation strategies, especially for patients with human papillomavirus associated-oropharyngeal cancer (OPC) and nasopharyngeal cancer (NPC). Furthermore, PT could have potentially greater immunogenic effects than conventional photon therapy, possibly enhancing both the radiotherapy (RT) capability to activate anti-tumor immune response and the effectiveness of immunotherapy drugs. Based on these premises, the aim of the present paper is to conduct a narrative review reporting the safety and efficacy of PT compared to photon RT focusing on NPC and OPC. We also provide a snapshot of ongoing clinical trials comparing PT with photon RT for these two clinical scenarios. Finally, we discuss new insights that may further develop clinical research on PT for HNC.
近几十年来，人们对质子治疗（PT）的兴趣与日俱增，这是有依据的，因为有证据表明质子剂量分布能够在肿瘤深度实现最大剂量释放，随后剂量在远端急剧下降。但是，在头颈部癌（HNC）的整体管理中，将PT的潜力仅仅局限于剂量学优势似乎过于简单化了。事实上，PT的精确靶向可能有助于评估降级治疗策略的有效性，特别是对于人乳头瘤病毒相关口咽癌（OPC）和鼻咽癌（NPC）患者。此外，PT可能比传统光子治疗具有更大的免疫原性效应，这可能会增强放射治疗（RT）激活抗肿瘤免疫反应的能力以及免疫治疗药物的疗效。基于这些前提，本文的目的是进行一项叙述性综述，报告与光子放疗相比，PT针对NPC和OPC的安全性和疗效。我们还提供了正在进行的将PT与光子放疗用于这两种临床情况的比较临床试验的简要情况。最后，我们讨论了可能进一步推动HNC的PT临床研究发展的新见解。
