Skip to main content

Proton Beam Therapy for Head and Neck Cancer

  • Chapter
  • First Online:
Head and Neck Cancer

Abstract

The goal of multimodality therapy for head and neck cancer is to improve the therapeutic ratio by increasing the tumor control probability and decreasing treatment-related toxicity. Due to the close spatial relationship of head and neck cancers to numerous normal anatomical structures, conventional photon radiation therapy can be associated with significant acute and long-term treatment-related toxicities. Superior dose localization properties of proton radiation therapy allow smaller volumes of normal tissues to be irradiated than is feasible with any photon technique. Initial clinical experience with proton radiation therapy in the treatment of head and neck cancers is promising. Prospective trials are underway to define the role of proton radiation therapy in the treatment of head and neck and skull base tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wilson RR. Radiological use of fast protons. Radiology. 1946;47:487–91.

    PubMed  CAS  Google Scholar 

  2. Suit H et al. Evaluation of the clinical applicability of proton beams in definitive fractionated radiation therapy. Int J Radiat Oncol Biol Phys. 1982;8(12):2199–205.

    Article  PubMed  CAS  Google Scholar 

  3. October 28, 2010; Available from: http://ptcog.web.psi.ch/­ptcentres.html.

  4. Rutherford E. Engineering. 1920;CX(2854).

    Google Scholar 

  5. Suit HD. Protons to replace photons in external beam radiation therapy? Clin Oncol (R Coll Radiol). 2003;15(1):S29–31.

    CAS  Google Scholar 

  6. Suit H et al. Proton beams to replace photon beams in radical dose treatments. Acta Oncol. 2003;42(8):800–8.

    Article  PubMed  Google Scholar 

  7. Kanai T et al. Spot scanning system for proton radiotherapy. Med Phys. 1980;7(4):365–9.

    Article  PubMed  CAS  Google Scholar 

  8. Bortfeld T et al. Effects of intra-fraction motion on IMRT dose delivery: statistical analysis and simulation. Phys Med Biol. 2002;47(13):2203–20.

    Article  PubMed  Google Scholar 

  9. Lambert J et al. Intrafractional motion during proton beam scanning. Phys Med Biol. 2005;50(20):4853–62.

    Article  PubMed  CAS  Google Scholar 

  10. Goitein M. Magical protons? Int J Radiat Oncol Biol Phys. 2008;70(3):654–6.

    Article  PubMed  Google Scholar 

  11. Urie M et al. Degradation of the Bragg peak due to inhomogeneities. Phys Med Biol. 1986;31(1):1–15.

    Article  PubMed  CAS  Google Scholar 

  12. Goitein M. Calculation of the uncertainty in the dose delivered during radiation therapy. Med Phys. 1985;12(5):608–12.

    Article  PubMed  CAS  Google Scholar 

  13. Lomax A. Intensity-modulated proton therapy. In: DeLaney T, Kooy H, editors. Proton and charged particle radiotherapy. Philadelphia: Lippincott Williams and Wilkins; 2008. p. 98–107.

    Google Scholar 

  14. Steneker M, Lomax A, Schneider U. Intensity modulated photon and proton therapy for the treatment of head and neck tumors. Radiother Oncol. 2006;80(2):263–7.

    Article  PubMed  CAS  Google Scholar 

  15. ICRU. Prescribing, recording, and reporting proton-beam therapy (ICRU Report 78). J ICRU. 2007;7(2):89–91.

    Google Scholar 

  16. Hall EJ, Giaccia AJ. Radiobiology for the radiologist. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. ix, 546.

    Google Scholar 

  17. Paganetti H et al. Relative biological effectiveness (RBE) values for proton beam therapy. Int J Radiat Oncol Biol Phys. 2002;53(2):407–21.

    Article  PubMed  Google Scholar 

  18. Gerweck LE, Kozin SV. Relative biological effectiveness of proton beams in clinical therapy. Radiother Oncol. 1999;50(2):135–42.

    Article  PubMed  CAS  Google Scholar 

  19. Blanco AI et al. Carcinoma of paranasal sinuses: long-term outcomes with radiotherapy. Int J Radiat Oncol Biol Phys. 2004;59(1):51–8.

    Article  PubMed  Google Scholar 

  20. Chen AM et al. Carcinomas of the paranasal sinuses and nasal cavity treated with radiotherapy at a single institution over five decades: are we making improvement? Int J Radiat Oncol Biol Phys. 2007;69(1):141–7.

    Article  PubMed  Google Scholar 

  21. Jansen EP et al. Does the combination of radiotherapy and debulking surgery favor survival in paranasal sinus carcinoma? Int J Radiat Oncol Biol Phys. 2000;48(1):27–35.

    Article  PubMed  CAS  Google Scholar 

  22. Katz TS et al. Malignant tumors of the nasal cavity and paranasal sinuses. Head Neck. 2002;24(9):821–9.

    Article  PubMed  Google Scholar 

  23. Daly ME et al. Intensity-modulated radiation therapy for ­malignancies of the nasal cavity and paranasal sinuses. Int J Radiat Oncol Biol Phys. 2007;67(1):151–7.

    Article  PubMed  Google Scholar 

  24. Jiang GL et al. Maxillary sinus carcinomas: natural history and results of postoperative radiotherapy. Radiother Oncol. 1991;21(3):193–200.

    Article  PubMed  CAS  Google Scholar 

  25. Dulguerov P et al. Nasal and paranasal sinus carcinoma: are we making progress? A series of 220 patients and a systematic review. Cancer. 2001;92(12):3012–29.

    Article  PubMed  CAS  Google Scholar 

  26. Mendenhall WM et al. Radiotherapy alone or combined with surgery for adenoid cystic carcinoma of the head and neck. Head Neck. 2004;26(2):154–62.

    Article  PubMed  Google Scholar 

  27. Kim GE et al. Adenoid cystic carcinoma of the maxillary antrum. Am J Otolaryngol. 1999;20(2):77–84.

    Article  PubMed  CAS  Google Scholar 

  28. Lavertu P et al. Squamous cell carcinoma of the paranasal sinuses: the Cleveland Clinic experience 1977-1986. Laryngoscope. 1989;99(11):1130–6.

    Article  PubMed  CAS  Google Scholar 

  29. Vikram B et al. Radiation therapy in adenoid-cystic carcinoma. Int J Radiat Oncol Biol Phys. 1984;10(2):221–3.

    Article  PubMed  CAS  Google Scholar 

  30. Garden AS et al. The influence of positive margins and nerve invasion in adenoid cystic carcinoma of the head and neck treated with surgery and radiation. Int J Radiat Oncol Biol Phys. 1995;32(3):619–26.

    Article  PubMed  CAS  Google Scholar 

  31. Takeda A et al. Late retinal complications of radiation therapy for nasal and paranasal malignancies: relationship between irradiated-dose area and severity. Int J Radiat Oncol Biol Phys. 1999;44(3):599–605.

    Article  PubMed  CAS  Google Scholar 

  32. Waldron JN et al. Ethmoid sinus cancer: twenty-nine cases managed with primary radiation therapy. Int J Radiat Oncol Biol Phys. 1998;41(2):361–9.

    Article  PubMed  CAS  Google Scholar 

  33. Parsons JT et al. Severe dry-eye syndrome following external beam irradiation. Int J Radiat Oncol Biol Phys. 1994;30(4):775–80.

    PubMed  CAS  Google Scholar 

  34. Hoppe BS et al. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative ­setting – the MSKCC experience. Int J Radiat Oncol Biol Phys. 2007;67(3):691–702.

    Article  PubMed  Google Scholar 

  35. Cianchetti M et al. Long-term Outcome of Proton Beam Therapy for Advanced Sinonasal Malignancies. Chandler, AZ: Multidisciplinary Head and Neck Cancer Symposium Annual Meeting; 2010.

    Google Scholar 

  36. Pommier P et al. Proton beam radiation therapy for skull base adenoid cystic carcinoma. Arch Otolaryngol Head Neck Surg. 2006;132(11):1242–9.

    Article  PubMed  Google Scholar 

  37. Douglas JG et al. Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy. Int J Radiat Oncol Biol Phys. 2000;46(3):551–7.

    Article  PubMed  CAS  Google Scholar 

  38. Truong MT et al. Proton radiation therapy for primary sphenoid sinus malignancies: treatment outcome and prognostic factors. Head Neck. 2009;31(10):1297–308.

    Article  PubMed  Google Scholar 

  39. Weber DC et al. Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/­protons. Radiother Oncol. 2006;81(3):243–9.

    Article  PubMed  Google Scholar 

  40. Al-Sarraf M et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16(4):1310–7.

    PubMed  CAS  Google Scholar 

  41. Lee AW et al. Major late toxicities after conformal radiotherapy for nasopharyngeal carcinoma-patient- and treatment-related risk factors. Int J Radiat Oncol Biol Phys. 2009;73(4):1121–8.

    Article  PubMed  Google Scholar 

  42. Lee AW et al. Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol. 2005;23(28):6966–75.

    Article  PubMed  CAS  Google Scholar 

  43. Kam MK et al. Prospective randomized study of intensity-­modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol. 2007;25(31):4873–9.

    Article  PubMed  Google Scholar 

  44. Pow EH et al. Xerostomia and quality of life after ­intensity-­modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66(4):981–91.

    Article  PubMed  Google Scholar 

  45. Denis F et al. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004;22(1):69–76.

    Article  PubMed  Google Scholar 

  46. Fu KK et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000;48(1):7–16.

    Article  PubMed  CAS  Google Scholar 

  47. Brizel DM et al. Hyperfractionated irradiation with or without ­concurrent chemotherapy for locally advanced head and neck ­cancer. N Engl J Med. 1998;338(25):1798–804.

    Article  PubMed  CAS  Google Scholar 

  48. Adelstein DJ et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21(1):92–8.

    Article  PubMed  Google Scholar 

  49. Chao KS et al. Intensity-modulated radiation therapy for oropharyngeal carcinoma: impact of tumor volume. Int J Radiat Oncol Biol Phys. 2004;59(1):43–50.

    Article  PubMed  Google Scholar 

  50. Garden AS et al. Disease-control rates following intensity-­modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2007;67(2):438–44.

    Article  PubMed  Google Scholar 

  51. Lee NY et al. A comparison of intensity-modulated radiation therapy and concomitant boost radiotherapy in the setting of concurrent chemotherapy for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006;66(4):966–74.

    Article  PubMed  Google Scholar 

  52. Eisbruch A et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010;76:1333–8.

    Article  PubMed  Google Scholar 

  53. Slater JD et al. Proton radiation for treatment of cancer of the oropharynx: early experience at Loma Linda University Medical Center using a concomitant boost technique. Int J Radiat Oncol Biol Phys. 2005;62(2):494–500.

    Article  PubMed  Google Scholar 

  54. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006;65(1):1–7.

    Article  PubMed  Google Scholar 

  55. National Council on Radiation Protection and Measurements. The relative biological effectiveness of radiations of different quality. NRCP Report 104. Bethesda, MD: NRCP; 1990.

    Google Scholar 

  56. Jiang H et al. Simulation of organ-specific patient effective dose due to secondary neutrons in proton radiation treatment. Phys Med Biol. 2005;50(18):4337–53.

    Article  PubMed  Google Scholar 

  57. Brenner DJ, Hall EJ. Secondary neutrons in clinical proton radiotherapy: a charged issue. Radiother Oncol. 2008;86(2):165–70.

    Article  PubMed  Google Scholar 

  58. Kocher DC, Apostoaei AI, Hoffman FO. Radiation effectiveness factors for use in calculating probability of causation of radiogenic cancers. Health Phys. 2005;89(1):3–32.

    Article  PubMed  CAS  Google Scholar 

  59. Paganetti H, Bortfeld T, Delaney TF. Neutron dose in proton radiation therapy: in regard to Eric J. Hall (Int J Radiat Oncol Biol Phys 2006;65:1-7). Int J Radiat Oncol Biol Phys. 2006;66(5):1594–5. author reply 1595.

    PubMed  Google Scholar 

  60. Gottschalk B. Neutron dose in scattered and scanned proton beams: in regard to Eric J. Hall (Int J Radiat Oncol Biol Phys 2006;65:1-7). Int J Radiat Oncol Biol Phys. 2006;66(5):1594. author reply 1595.

    PubMed  Google Scholar 

  61. Miralbell R et al. Potential reduction of the incidence of ­radiation-induced second cancers by using proton beams in the treatment of pediatric tumors. Int J Radiat Oncol Biol Phys. 2002;54(3):824–9.

    Article  PubMed  Google Scholar 

  62. Jarlskog CZ, Paganetti H. Sensitivity of different dose scoring methods on organ-specific neutron dose calculations in proton therapy. Phys Med Biol. 2008;53(17):4523–32.

    Article  PubMed  Google Scholar 

  63. Chung CS et al. Comparative analysis of second malignancy risk in patients treated with proton therapy versus conventional photon therapy. Int J Radiat Oncol Biol Phys. 2008;72(1):S8.

    Article  Google Scholar 

  64. Goitein M, Cox JD. Should randomized clinical trials be required for proton radiotherapy? J Clin Oncol. 2008;26(2):175–6.

    Article  PubMed  Google Scholar 

  65. Glatstein E et al. Should randomized clinical trials be required for proton radiotherapy? An alternative view. J Clin Oncol. 2008;26(15):2438–9.

    Article  PubMed  Google Scholar 

  66. Bentzen SM. Randomized controlled trials in health technology assessment: overkill or overdue? Radiother Oncol. 2008;86(2):142–7.

    Article  PubMed  Google Scholar 

  67. Suit H et al. Should positive phase III clinical trial data be required before proton beam therapy is more widely adopted? No. Radiother Oncol. 2008;86(2):148–53.

    Article  PubMed  Google Scholar 

  68. Tepper JE. Protons and parachutes. J Clin Oncol. 2008;26(15):2436–7.

    Article  PubMed  Google Scholar 

  69. Schulz RJ, Kagan AR. Should proton-beam therapy be widely adopted? Int J Radiat Oncol Biol Phys. 2008;72(5):1307–9. discussion 1309–10.

    Article  PubMed  Google Scholar 

  70. Goitein M, Jermann M. The relative costs of proton and X-ray radiation therapy. Clin Oncol (R Coll Radiol). 2003;15(1):S37–50.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Annie W. Chan .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Margalit, D.N., Adams, J.A., Chan, A.W. (2011). Proton Beam Therapy for Head and Neck Cancer. In: Bernier, J. (eds) Head and Neck Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9464-6_43

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-9464-6_43

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-9463-9

  • Online ISBN: 978-1-4419-9464-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics