Early clinical study of intensity modulated proton therapy shows positive outcomes; quality of life benefits for head and neck cancer patients
In a small study, researchers from The University of Texas MD Anderson Cancer Center found that 93 percent of head and neck cancer patients treated with multi-field optimization intensity modulated proton therapy (MFO-IMPT) were cancer-free 28 months after treatment. Side effects typical of standard radiation were also reduced in some cases. These preliminary results suggest that proton therapy may be an effective and less toxic treatment option for patients with head and neck cancer.
Published in the International Journal of Radiation, Oncology, Biology, Physics, the first of its kind study supports ongoing research by MD Anderson’s Proton Therapy Center regarding the benefits of proton therapy and, most recently, MFO-IMPT, which is best used to deliver a precise dose of protons to the most complicated tumors – ones that largely reside embedded in the nooks and crannies of the head and neck or at the base of the skull.
MFO-IMPT has the ability to spare surrounding healthy tissue from damage and help preserve quality of life measures such as neurocognitive function, vision, the ability to swallow, hearing, taste and speech. The current standard of treatment delivery for head and neck cancer, intensity modulated radiation therapy (IMRT), destroys both cancerous and healthy cells, impairing some of the functions listed above.
The prospective study followed 15 head and neck cancer patients: 10 squamous cell carcinoma (SCC) and five adenoid cystic carcinoma (ACC) cases treated with MFO-IMPT. Five of the SCC patients underwent induction chemotherapy before receiving proton therapy. All five ACC patients received chemotherapy concurrent with MFO-IMPT. At 28 months, all ten SCC patients and four of the ACC patients remained cancer-free. The results also showed a reduction in side effects:
- All patients completed treatment without any breaks, chemotherapy dose reductions or hospitalizations.
- None of the patients who underwent MFO-IMPT with concurrent chemotherapy experienced nausea or vomiting.
- Also, none of the patients experienced severe dermatitis (inflammation of the skin).
“Though early, this study provides the first evidence that proton therapy for head and neck cancers, which are becoming increasingly common, is safe and effective,” said Steven J. Frank, M.D., Medical Director of the Proton Therapy Center, associate professor of Radiation Oncology at MD Anderson. “As incidence of HPV-related head and neck cancers rise, it’s important to have treatment options that minimize long-term side effects. These patients are typically younger, are raising families and we hope have 30-40 years to look forward to as cancer survivors. The quality of those years is crucial.”
According to Frank, also the study’s lead author, ongoing research will determine if MFO-IMPT is able to reduce toxicity and improve survival.
MD Anderson treated its first MFO-IMPT patient in 2010; approximately 300 patients, many with complex head and neck cancers, have been treated with this form of proton therapy at the Proton Therapy Center to date.
Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice, Steven J. Frank, MD, James D. Cox, MD, Michael Gillin, PhD, Radhe Mohan, PhD, Adam S. Garden, MD, David I. Rosenthal, MD, G. Brandon Gunn, MD, Randal S. Weber, MD, Merrill S. Kies, MD, Jan S. Lewin, PhD, Mark F. Munsell, MS, Matthew B. Palmer, BS, Narayan Sahoo, PhD, Xiaodong Zhang, PhD, Wei Liu, PhD, X. Ronald Zhu, PhD, International Journal of Radiation, Oncology, Biology, Physics, DOI:10.1016/j.ijrobp.2014.04.019, published online 26 May 2014.