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• W2972319443 abstract "Advances in radiotherapy technique have improved tumor control and reduced toxicity in the management of nasopharyngeal carcinoma (NPC). Local failure remains a problem for some patients with very advanced primary tumors, and both acute and late toxicities are significant given the large anatomic volume treated and close proximity of tumor to numerous critical structures. Proton therapy (PT) offers dosimetric advantage over IMRT, which can further improve the therapeutic ratio. There is still limited clinical data reported. We report our early clinical outcomes with PT for locally advanced NPC. We reviewed treatment records of patients enrolled on a prospective IRB-approved clinical registry study who received PT for definitive treatment of NPC. Demographics, dosimetry, disease control outcomes, and acute and late toxicities were reviewed (CTCAE v.4). Analyses were done using descriptive statistics. 21 patients were treated from 2015-2018. There were 6 females and 15 males, with median age 57 (range 19-73). T stage distribution was T1, 4; T2, 4; T3, 1; T4, 12. N stage distribution was N0, 2; N1, 7; N2, 10; N3, 2. 95% had stage III-IV disease. WHO classification was type 1 in 6, type 2/3 in 14, unknown in 1. 71% were EBV positive. A dose-painted pencil beam scanning approach was used with 2-5 beams encompassing primary and bilateral neck. Majority was treated to 69.96 CGE, in 33 fractions once daily; 2 underwent hyperfractionated accelerated treatment twice daily. All received concurrent CDDP delivered either every 3 weeks, 17 or low dose weekly, 4; 5 also received induction chemotherapy. With median follow up of 16 mos (range 1-42 and 14 patients with >1 year), 18 patients are NED, 1 developed local failure who had a WHO I, T4 primary with intracranial extension and 2 developed distant metastases. Locoregional control rate was 95%, DM free rate 90%, and OS was 90%. Acute toxicities included grade 3 mucositis in 14, grade 3 dermatitis in 9. PEG utilization included prophylactic, 10; reactive, 4; none, 7. Late toxicities included grade 2 xerostomia in 2, hearing loss in 3, and only 1 patient remains PEG-dependent. Proton therapy is feasible in locally advanced NPC with early outcomes demonstrating excellent locoregional control and favorable toxicity profile. This is consistent with early results from other single institutions. Longer follow up and additional comparative studies are needed to evaluate the relative advantages compared to IMRT." @default.
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• W2972319443 date "2019-09-01" @default.
• W2972319443 modified "2023-09-27" @default.
• W2972319443 title "Proton Radiotherapy for Locally Advanced Nasopharyngeal Carcinoma: Early Clinical Outcomes From a Single Institution" @default.
• W2972319443 doi "https://doi.org/10.1016/j.ijrobp.2019.06.1576" @default.
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