Chang Chia-Lun, Lin Kuan-Chou, Chen Wan-Ming, Shia Ben-Chang, Wu Szu-Yuan
Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University Taipei, Taiwan.
Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
Radiother Oncol. 2023 Oct 28:109971. doi: 10.1016/j.radonc.2023.109971.
To compare the oncologic outcomes between proton therapy and intensity-modulated radiation therapy (IMRT) for head and neck squamous cell carcinoma (HNSCC) patients undergoing curative radiotherapy (RT).
We studied HNSCC patients who underwent curative-intent RT from 2015 to 2019, comparing the oncologic outcomes of proton therapy and IMRT. Our national retrospective HNSCC cohort study involved three institutes with proton therapy and 17 institutes (medical center levels) with IMRT in Taiwan. We utilized the Taiwan Cancer Registry Database to collect medical data for this study. We classified patients into two groups based on treatment method: Group 1 received IMRT, while Group 2 received proton therapy. 3:1 propensity score matching was performed to minimize the impact of potential confounders. Cox proportional hazards models were used to evaluate oncologic outcomes.
This study of 60,485 patients with HNSCC found that proton therapy was associated with better overall and cancer-specific survival and lower locoregional recurrence rates than IMRT. After matching, 982 patients were analyzed, with well-balanced factors. Proton therapy was a significant predictor of all-cause mortality, cancer-specific death, and locoregional recurrence (LRR). Patients who received proton therapy had significantly lower risks of all-cause mortality (adjusted hazard ratio, aHR=0.43), cancer-specific death (aHR=0.44), and LRR (aHR=0.61) than those who received IMRT.
Proton therapy is associated with superior outcomes in terms of overall survival, cancer-specific survival, and locoregional recurrence rates compared to IMRT in patients with HNSCC. These results provide valuable evidence for clinicians and patients in decision-making regarding the choice of radiation therapy for HNSCC.
比较接受根治性放疗（RT）的头颈部鳞状细胞癌（HNSCC）患者接受质子治疗与调强放射治疗（IMRT）后的肿瘤学结局。
我们研究了2015年至2019年接受根治性放疗的HNSCC患者，比较了质子治疗和IMRT的肿瘤学结局。我们的全国性回顾性HNSCC队列研究涉及台湾3家有质子治疗设备的机构和17家（医疗中心级别）有IMRT设备的机构。我们利用台湾癌症登记数据库收集本研究的医疗数据。我们根据治疗方法将患者分为两组：第1组接受IMRT，第2组接受质子治疗。进行3:1倾向评分匹配以尽量减少潜在混杂因素的影响。使用Cox比例风险模型评估肿瘤学结局。
这项对60485例HNSCC患者的研究发现，与IMRT相比，质子治疗与更好的总生存率和癌症特异性生存率以及更低的局部区域复发率相关。匹配后，对982例患者进行了分析，各因素均衡。质子治疗是全因死亡率、癌症特异性死亡和局部区域复发（LRR）的显著预测因素。接受质子治疗的患者全因死亡率（调整后风险比，aHR = 0.43）、癌症特异性死亡（aHR = 0.44）和LRR（aHR = 0.61）的风险显著低于接受IMRT的患者。
与IMRT相比，质子治疗在HNSCC患者的总生存率、癌症特异性生存率和局部区域复发率方面具有更好的结局。这些结果为临床医生和患者在选择HNSCC放射治疗方案时的决策提供了有价值的证据。
