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Comparing the Oncologic Outcomes of Proton Therapy and Intensity-Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma
34 Pages Posted: 5 Jun 2023More...
Purpose: 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).
Experimental Design: We studied HNSCC patients who underwent curative-intent RT from 2015 to 2019, comparing the oncologic outcomes of proton therapy and IMRT. We classified patients into two groups based on treatment method: Group 1 received IMRT, while Group 2 received proton therapy. 3:1 PSM was performed to minimize the impact of potential confounders. Cox proportional hazards models were used to evaluate oncologic outcomes.
Results: 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.
Conclusion: 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.
Funding: Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, supports Szu- Yuan Wu’s work (Funding Number: 10908, 10909, 11001, 11002, 11003, 11006, and 11013).
Declaration of Interest: The authors have no potential conflicts of interest to declare. The data sets supporting the study conclusions are included in the manuscript.
Ethical Approval: The study protocols were reviewed and approved by the Institutional Review Board of Tzu-Chi Medical Foundation (IRB109-015-B).
Keywords: Proton Therapy, IMRT, HNSCC, Survival, Recurrence, Metastasis
Suggested Citation: Suggested Citation