Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit
Abstract Introduction Radiation-induced oral mucositis (RIOM), is a common, debilitating, acute side effect of radiotherapy for oral cavity (OC) and oropharyngeal (OPx) cancers; technical innovations for reducing it are seldom discussed. Intensity-modulated-proton-therapy (IMPT) has been reported ex...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-07-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02317-1 |
| _version_ | 1797773995649531904 |
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| author | Sapna Nangia Utpal Gaikwad M. P. Noufal Mayur Sawant Manoj Wakde Ashwathy Mathew Srinivas Chilukuri Dayananda Sharma Rakesh Jalali |
| author_facet | Sapna Nangia Utpal Gaikwad M. P. Noufal Mayur Sawant Manoj Wakde Ashwathy Mathew Srinivas Chilukuri Dayananda Sharma Rakesh Jalali |
| author_sort | Sapna Nangia |
| collection | DOAJ |
| description | Abstract Introduction Radiation-induced oral mucositis (RIOM), is a common, debilitating, acute side effect of radiotherapy for oral cavity (OC) and oropharyngeal (OPx) cancers; technical innovations for reducing it are seldom discussed. Intensity-modulated-proton-therapy (IMPT) has been reported extensively for treating OPx cancers, and less frequently for OC cancers. We aim to quantify the reduction in the likelihood of RIOM in treating these 2 subsites with IMPT compared to Helical Tomotherapy. Material and methods We report acute toxicities and early outcomes of 22 consecutive patients with OC and OPx cancers treated with IMPT, and compare the dosimetry and normal tissue complication probability (NTCP) of ≥ grade 3 mucositis for IMPT and HT. Results Twenty two patients, 77% males, 41% elderly and 73% OC subsite, were reviewed. With comparable target coverage, IMPT significantly reduced the mean dose and D32, D39, D45, and D50, for both the oral mucosa (OM) and spared oral mucosa (sOM). With IMPT, there was a 7% absolute and 16.5% relative reduction in NTCP for grade 3 mucositis for OM, compared to HT. IMPT further reduced NTCP for sOM, and the benefit was maintained in OC, OPx subsites and elderly subgroup. Acute toxicities, grade III dermatitis and mucositis, were noted in 50% and 45.5% patients, respectively, while 22.7% patients had grade 3 dysphagia. Compared with published data, the hospital admission rate, median weight loss, feeding tube insertion, unplanned treatment gaps were lower with IMPT. At a median follow-up of 15 months, 81.8% were alive; 72.7%, alive without disease and 9%, alive with disease. Conclusion The dosimetric benefit of IMPT translates into NTCP reduction for grade 3 mucositis compared to Helical Tomotherapy for OPx and OC cancers and encourages the use of IMPT in their management. |
| first_indexed | 2024-03-12T22:14:31Z |
| format | Article |
| id | doaj.art-05952d74844a4821ae85040117007e69 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-12T22:14:31Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-05952d74844a4821ae85040117007e692023-07-23T11:21:37ZengBMCRadiation Oncology1748-717X2023-07-0118111010.1186/s13014-023-02317-1Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefitSapna Nangia0Utpal Gaikwad1M. P. Noufal2Mayur Sawant3Manoj Wakde4Ashwathy Mathew5Srinivas Chilukuri6Dayananda Sharma7Rakesh Jalali8Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic EstateDepartment of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic EstateDepartment of Medical Physics, Apollo Proton Cancer CentreDepartment of Radiation Oncology, Tata Memorial CentreDepartment of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic EstateDepartment of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic EstateDepartment of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic EstateDepartment of Medical Physics, Apollo Proton Cancer CentreDepartment of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic EstateAbstract Introduction Radiation-induced oral mucositis (RIOM), is a common, debilitating, acute side effect of radiotherapy for oral cavity (OC) and oropharyngeal (OPx) cancers; technical innovations for reducing it are seldom discussed. Intensity-modulated-proton-therapy (IMPT) has been reported extensively for treating OPx cancers, and less frequently for OC cancers. We aim to quantify the reduction in the likelihood of RIOM in treating these 2 subsites with IMPT compared to Helical Tomotherapy. Material and methods We report acute toxicities and early outcomes of 22 consecutive patients with OC and OPx cancers treated with IMPT, and compare the dosimetry and normal tissue complication probability (NTCP) of ≥ grade 3 mucositis for IMPT and HT. Results Twenty two patients, 77% males, 41% elderly and 73% OC subsite, were reviewed. With comparable target coverage, IMPT significantly reduced the mean dose and D32, D39, D45, and D50, for both the oral mucosa (OM) and spared oral mucosa (sOM). With IMPT, there was a 7% absolute and 16.5% relative reduction in NTCP for grade 3 mucositis for OM, compared to HT. IMPT further reduced NTCP for sOM, and the benefit was maintained in OC, OPx subsites and elderly subgroup. Acute toxicities, grade III dermatitis and mucositis, were noted in 50% and 45.5% patients, respectively, while 22.7% patients had grade 3 dysphagia. Compared with published data, the hospital admission rate, median weight loss, feeding tube insertion, unplanned treatment gaps were lower with IMPT. At a median follow-up of 15 months, 81.8% were alive; 72.7%, alive without disease and 9%, alive with disease. Conclusion The dosimetric benefit of IMPT translates into NTCP reduction for grade 3 mucositis compared to Helical Tomotherapy for OPx and OC cancers and encourages the use of IMPT in their management.https://doi.org/10.1186/s13014-023-02317-1ProtonNTCPMucositisOral cavityOropharyngeal |
| spellingShingle | Sapna Nangia Utpal Gaikwad M. P. Noufal Mayur Sawant Manoj Wakde Ashwathy Mathew Srinivas Chilukuri Dayananda Sharma Rakesh Jalali Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit Radiation Oncology Proton NTCP Mucositis Oral cavity Oropharyngeal |
| title | Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit |
| title_full | Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit |
| title_fullStr | Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit |
| title_full_unstemmed | Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit |
| title_short | Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit |
| title_sort | proton therapy and oral mucositis in oral oropharyngeal cancers outcomes dosimetric and ntcp benefit |
| topic | Proton NTCP Mucositis Oral cavity Oropharyngeal |
| url | https://doi.org/10.1186/s13014-023-02317-1 |
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