Proton Therapy Center Czech, Budínova 1a, Prague 8, 18000, Czech Republic.
Department of Health Care Disciplines and Population Protection, Faculty of Biomedical Engineering, Czech Technical University Prague, Sítná square 3105, Kladno, 272 01, Czech Republic.
Eur Arch Otorhinolaryngol. 2024 Oct;281(10):5447-5454. doi: 10.1007/s00405-024-08747-1. Epub 2024 Aug 28.
Patients with p16 positive tonsillar cancer (p16 + TC) have an excellent prognosis and long-life expectancy. Deintensification of therapy is a prevalent topic of discussion. Proton radiotherapy is one way to reduce radiation exposure and thus reduce acute and late toxicity. The aim is to evaluate treatment outcomes and toxicity of postoperative treatment with intensity-modulated proton therapy (IMPT).
Between September 2013 and November 2021, 47 patients with p16 + TC were treated postoperatively with IMPT. Median age was 54.9 (38.2-74.9) years, 31 were males and 16 were females. All patients had squamous cell carcinoma and underwent surgery as a primary treatment. Median dose of radiotherapy was 66 GyE in 33 fractions. Bilateral neck irradiation was used in 39 patients and unilateral in 8. Concomitant chemotherapy was applied in 24 patients.
Median follow-up time was 4.2 (0.15-9.64) years. Five-year overall survival, relapse free survival and local control were 95.7%, 97.8% and 100%. The most common acute toxicities were dermatitis and mucositis, with grade 2 + in 61.7% and 70.2% of patients. No acute percutaneous gastrostomy insertion was necessary and intravenous rehydration was used in 12.8% of patients. The most common late toxicity was grade 1 xerostomia in 70.2% of patients and grade 2 in 10.6% of patients. Subcutaneous fibrosis of grades 2 and 3 occurred in 17.0% and 2.1% of patients, respectively. One patient developed late severe dysphagia and became PEG-dependent.
IMPT for the postoperative treatment of p16 + TC is feasible with excellent efficiency and acceptable acute and late toxicity.
p16 阳性扁桃体癌（p16+TC）患者预后良好，预期寿命长。降低治疗强度是目前讨论的热门话题。质子放射治疗是减少辐射暴露从而降低急性和迟发性毒性的一种方法。本研究旨在评估术后应用调强质子治疗（IMPT）的治疗效果和毒性。
2013 年 9 月至 2021 年 11 月，47 例 p16+TC 患者术后接受 IMPT 治疗。中位年龄为 54.9（38.2-74.9）岁，男性 31 例，女性 16 例。所有患者均为鳞状细胞癌，均行手术作为初始治疗。放疗中位剂量为 66GyE，共 33 次。39 例患者行双侧颈部照射，8 例患者行单侧照射。24 例患者接受同期化疗。
中位随访时间为 4.2（0.15-9.64）年。5 年总生存率、无复发生存率和局部控制率分别为 95.7%、97.8%和 100%。最常见的急性毒性是皮炎和黏膜炎，分别有 61.7%和 70.2%的患者出现 2+级毒性。无患者需要行急性经皮胃造口术，12.8%的患者给予静脉补液。最常见的迟发性毒性是 70.2%的患者出现 1 级口干，10.6%的患者出现 2 级口干。2 级和 3 级皮下纤维化分别发生在 17.0%和 2.1%的患者中。1 例患者出现晚期严重吞咽困难，成为 PEG 依赖者。
p16+TC 术后应用 IMPT 治疗是可行的，具有良好的疗效，且急性和迟发性毒性可接受。
