Summary
The management of head and neck tumors is challenging and requires a multidisciplinary approach. Besides the common histology of squamous cell cancer, other histologies like adenoid cystic carcinoma, mucosal melanoma, and adenocarcinoma are often present. These tumors are radioresistant and need high radiation doses. Photon beam therapy is often limited by the normal tissue tolerance, and particle therapy using protons or carbon ions is a valuable treatment option. Due to their dosimetric advantages, protons enable deposition of high tumor doses, while optimally sparing the surrounding tissue. Carbon ions offer the additional advantage of a higher linear energy transfer (LET) which results in a higher biological effectiveness of tumor cell damage. Therefore, while protons can also be used in sterilizing microscopic disease, carbon ions should be considered in large macroscopic disease, where a significant tumor burden has to be managed.
Similar content being viewed by others
References
Leeman JE, Romesser PB, Zhou Y, McBride S, Riaz N, Sherman E, et al. Proton therapy for head and neck cancer: expanding the therapeutic window. Lancet Oncol. 2017;18(5):254–65. https://doi.org/10.1016/S1470-2045(17)30179-1.
Park SG, Ahn YC, Oh D, Noh JM, Ju SG, Kwon D, et al. Early clinical outcomes of helical tomotherapy/intensity-modulated proton therapy combination in nasopharynx cancer. Cancer Sci. 2019;110(9):2867–74.
Beddok A, Feuvret L, Noel G, Bolle S, Deberne M, Mammar H, et al. Efficacy and toxicity of proton with photon radiation for locally advanced nasopharyngeal carcinoma. Acta Oncol (Madr). 2019;58(4):472–4. https://doi.org/10.1080/0284186X.2018.1543948.
Akbaba S, Held T, Lang K, Forster T, Federspil P, Herfarth K, et al. Bimodal radiotherapy with active raster-scanning carbon ion radiotherapy and intensity-modulated radiotherapy in high-risk nasopharyngeal carcinoma results in excellent local control. Cancers (Basel). 2019;11(3):379.
Abe T, Ohno T, Koto M, Demizu Y, Suefuji H, Tsuji H, et al. A multi-institutional retrospective study of carbon-ion radiotherapy for non-squamous cell malignant tumors of the nasopharynx: Subanalysis of Japan Carbon-Ion Radiation Oncology Study Group study 1402 HN. Cancer Med. 2018;7(12):6077–83.
Slater JD, Yonemoto LT, Mantik DW, Bush DA, Preston W, Grove RI, 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.
Bagley AF, Ye R, Garden AS, Gunn GB, Rosenthal DI, Fuller CD, et al. Xerostomia-related quality of life for patients with oropharyngeal carcinoma treated with proton therapy. Radiother Oncol. 2019; https://doi.org/10.1016/j.radonc.2019.07.012.
Patel SH, Wang Z, Wong WW, Murad MH, Buckey CR, Mohammed K, et al. Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis. Lancet Oncol. 2014;15(9):1027–38. https://doi.org/10.1016/S1470-2045(14)70268-2.
Russo AL, Adams JA, Weyman EA, Busse PM, Goldberg SI, Varvares M, et al. Long-term outcomes after proton beam therapy for sinonasal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2016; https://doi.org/10.1016/j.ijrobp.2016.02.042.
Dagan R, Bryant C, Li Z, Yeung D, Justice J, Dzieglewiski P, et al. Outcomes of sinonasal cancer treated with proton therapy. Int J Radiat Oncol Biol Phys. 2016; https://doi.org/10.1016/j.ijrobp.2016.02.019.
Jensen AD, Poulakis M, Nikoghosyan AV, Welzel T, Uhl M, Federspil PA, et al. High-LET radiotherapy for adenoid cystic carcinoma of the head and neck: 15 years’ experience with raster-scanned carbon ion therapy. Radiother Oncol. 2016;118(2):272–80. https://doi.org/10.1016/j.radonc.2015.05.010.
Akbaba S, Ahmed D, Mock A, Held T, Bahadir S, Lang K, et al. Treatment outcome of 227 patients with sinonasal adenoid cystic carcinoma (ACC) after intensity modulated radiotherapy and active raster-scanning carbon ion boost: A 10-year single-center experience. Cancers (Basel). 2019;11(11):1–14.
Adeberg S, Akbaba S, Lang K, Held T, Verma V, Nikoghosyan A, et al. The phase 1/2 ACCEPT trial: concurrent cetuximab and intensity modulated radiation therapy with carbon Ion boost for adenoid cystic carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2019; https://doi.org/10.1016/j.ijrobp.2019.09.036.
Koto M, Demizu Y, Saitoh J‑I, Suefuji H, Tsuji H, Okimoto T, et al. Definitive carbon-ion radiation therapy for locally advanced sinonasal malignant tumors: Subgroup analysis of a multicenter study by the Japan Carbon-Ion Radiation Oncology Study group (J-CROS). Int J Radiat Oncol Biol Phys. 2018;102(2):353–61. https://doi.org/10.1016/j.ijrobp.2018.05.074.
Sulaiman NS, Demizu Y, Koto M, Saitoh J‑I, Suefuji H, Tsuji H, et al. Multicenter study of carbon-ion radiation therapy for adenoid cystic carcinoma of the head and neck: Subanalysis of the Japan Carbon-Ion Radiation Oncology Study group (J-CROS) study (1402 HN). Int J Radiat Oncol Biol Phys. 2018;100(3):639–46. https://doi.org/10.1016/j.ijrobp.2017.11.010.
Romesser PB, Cahlon O, Scher E, Zhou Y, Berry SL, Rybkin A, et al. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Radiother Oncol. 2016;118(2):286–92. https://doi.org/10.1016/j.radonc.2015.12.008.
Jensen AD, Nikoghosyan AV, Lossner K, Haberer T, Jäkel O, Münter MW, et al. COSMIC: a regimen of intensity modulated radiation therapy plus dose-escalated, raster-scanned carbon Ion boost for malignant salivary gland tumors: results of the prospective phase 2 trial. Int J Radiat Oncol Biol Phys. 2015;93(1):37–46.
Jensen AD, Poulakis M, Vanoni V, Uhl M, Chaudhri N, Federspil PA, et al. Carbon ion therapy (C12) for high-grade malignant salivary gland tumors (MSGTs) of the head and neck: do non-ACCs profit from dose escalation? Radiat Oncol. 2016;11(1):90. https://doi.org/10.1186/s13014-016-0657-z.
Adeberg S, Windisch P, Ehret F, Baur M, Akbaba S, Held T, et al. Intensity Modulated Radiotherapy (IMRT) with carbon Ion boost in the multimodal treatment of salivary duct carcinoma. Front Oncol. 2019; https://doi.org/10.3389/fonc.2019.01420.
Shirai K, Koto M, Demizu Y, Suefuji H, Ohno T, Tsuji H, et al. Multi-institutional retrospective study of mucoepidermoid carcinoma treated with carbon-ion radiotherapy. Cancer Sci. 2017; https://doi.org/10.1111/cas.13270.
Blanchard P, Gunn GB, Lin A, Foote RL, Lee NY, Frank SJ. Proton therapy for head and neck cancers. Semin Radiat Oncol. 2018;28(1):53–63. https://doi.org/10.1016/j.semradonc.2017.08.004.
Held T, Windisch P, Akbaba S, Lang K, El Shafie R, Bernhardt D, et al. Carbon ion reirradiation for recurrent head and neck cancer: a single-institutional experience. Int J Radiat Oncol Biol Phys. 2019;105(4):803–11.
Jensen AD, Poulakis M, Nikoghosyan AV, Chaudhri N, Uhl M, Münter MW, et al. Re-irradiation of adenoid cystic carcinoma: analysis and evaluation of outcome in 52 consecutive patients treated with raster-scanned carbon ion therapy. Radiother Oncol. 2015;114:182–8.
Hu J, Bao C, Gao J, Guan X, Hu W, Yang J, et al. Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: Initial results. Cancer. 2018;124(11):2427–37.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
P. Georg declares that she has no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Georg, P. Particle therapy in head and neck cancer—expanding therapeutic options. memo 13, 389–394 (2020). https://doi.org/10.1007/s12254-020-00623-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12254-020-00623-y