Comparative analysis of acute toxicities and patient reported outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) for the treatment of oropharyngeal cancer.

Autor: Manzar GS; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, USA., Lester SC; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Routman DM; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Harmsen WS; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA., Petersen MM; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA., Sloan JA; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, USA., Mundy DW; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Hunzeker AE; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Amundson AC; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Anderson JL; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Patel SH; Department of Radiation Oncology, Mayo Clinic, Phoenix, USA., Garces YI; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Halyard MY; Department of Radiation Oncology, Mayo Clinic, Phoenix, USA., McGee LA; Department of Radiation Oncology, Mayo Clinic, Phoenix, USA., Neben-Wittich MA; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Ma DJ; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Frank SJ; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA., Whitaker TJ; Department of Radiation Oncology, Mayo Clinic, Rochester, USA., Foote RL; Department of Radiation Oncology, Mayo Clinic, Rochester, USA. Electronic address: foote.robert@mayo.edu.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2020 Jun; Vol. 147, pp. 64-74. Date of Electronic Publication: 2020 Mar 29.
DOI: 10.1016/j.radonc.2020.03.010
Abstrakt: Background and Purpose: IMPT improves normal tissue sparing compared to VMAT in treating oropharyngeal cancer (OPC). Our aim was to assess if this translates into clinical benefits.
Materials and Methods: OPC patients treated with definitive or adjuvant IMPT or VMAT from 2013 to 2018 were included. All underwent prospective assessment using patient-reported-outcomes (PROs) (EORTC-QLQ-H&N35) and provider-assessed toxicities (CTCAEv4.03). End-of-treatment and pretreatment scores were compared. PEG-tube use, hospitalization, and narcotic use were retrospectively collected. Statistical analysis used the Wilcoxon Rank-Sum Test with propensity matching for PROs/provider-assessed toxicities, and t-tests for other clinical outcomes.
Results: 46 IMPT and 259 VMAT patients were included; median follow-up was 12 months (IMPT) and 30 months (VMAT). Baseline characteristics were balanced except for age (p = 0.04, IMPT were older) and smoking (p < 0.01, 10.9% IMPT >20PYs, 29.3% VMAT). IMPT was associated with lower PEG placement (OR = 0.27; 95% CI: 0.12-0.59; p = 0.001) and less hospitalization ≤60 days post-RT (OR = 0.21; 95% CI:0.07-0.6, p < 0.001), with subgroup analysis revealing strongest benefits in patients treated definitively or with concomitant chemoradiotherapy (CRT). IMPT was associated with a relative risk reduction of 22.3% for end-of-treatment narcotic use. Patients reported reduced cough and dysgeusia with IMPT (p < 0.05); patients treated definitively or with CRT also reported feeling less ill, reduced feeding tube use, and better swallow. Provider-assessed toxicities demonstrated less pain and mucositis with IMPT, but more mucosal infection.
Conclusion: IMPT is associated with improved PROs, reduced PEG-tube placement, hospitalization, and narcotic requirements. Mucositis, dysphagia, and pain were decreased with IMPT. Benefits were predominantly seen in patients treated definitively or with CRT.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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