Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy
Purpose: Proton therapy is an emerging therapy for several malignancies owing to its favorable therapeutic ratio. There are very limited data on the use of proton therapy in the management of thyroid carcinoma. Our objective was to review the safety, feasibility, and outcomes of proton therapy for p...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-07-01
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| Series: | International Journal of Particle Therapy |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-22-00005.1 |
| _version_ | 1827158235983904768 |
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| author | Irini Youssef, MD Jennifer Yoon, MD Nader Mohamed, BA Kaveh Zakeri, MD Robert H. Press, MD Yao Yu, MD Jung Julie Kang, MD, PhD Richard J. Wong, MD R. Michael Tuttle, MD Ashok Shaha, MD Eric Sherman, MD Nancy Y. Lee, MD |
| author_facet | Irini Youssef, MD Jennifer Yoon, MD Nader Mohamed, BA Kaveh Zakeri, MD Robert H. Press, MD Yao Yu, MD Jung Julie Kang, MD, PhD Richard J. Wong, MD R. Michael Tuttle, MD Ashok Shaha, MD Eric Sherman, MD Nancy Y. Lee, MD |
| author_sort | Irini Youssef, MD |
| collection | DOAJ |
| description | Purpose: Proton therapy is an emerging therapy for several malignancies owing to its favorable therapeutic ratio. There are very limited data on the use of proton therapy in the management of thyroid carcinoma. Our objective was to review the safety, feasibility, and outcomes of proton therapy for patients with thyroid cancer treated to the head and neck.
Methods: From our institution's proton database from 2012 to 2021, we identified 22 patients with thyroid cancer treated with proton beam therapy. We evaluated outcomes and toxicities.
Results: Median follow-up was 26 months. Of the 22 patients, 50% were female. The mean age was 65 years. Three patients had anaplastic cancer; 13, papillary carcinoma; 2, follicular carcinoma; and 2, poorly differentiated carcinoma. Forty-six percent had T4 disease. Primary targets were the central neck compartment, level VI, and upper mediastinum. Radiation dose was 60 GyRBE adjuvantly, and 70 GyRBE for gross disease (range, 6000-7600 GyRBE). Eight patients underwent upfront adjuvant radiation, and 3 received definitive radiation for unresectable disease upfront. Eleven patients received either salvage or palliative radiation. Fifty-nine percent of patients had extrathyroidal extension, and 64% of patients had gross disease in the neck before treatment. Fifty percent of patients had metastatic disease before treatment. Sixteen patients received concurrent chemotherapy, 63% of these patients received doxorubicin. For all patients, 1-year local regional recurrence (LRR) was 0%, and overall survival (OS) was 90%. Acute grade 3+ toxicities occurred in 27% of patients, the most frequent being dermatitis (27%). Three patients required a percutaneous endoscopic gastrostomy tube after radiation therapy (RT), 2 owing to progression. There were no grade 4+ toxicities.
Conclusions: Proton therapy for thyroid cancer appears feasible and effective with minimal toxicities. Prospective studies comparing proton therapy with intensity-modulated RT, to evaluate the clinical efficacy of using proton therapy to reduce toxicities in patients undergoing radiation for thyroid cancer, are warranted. |
| first_indexed | 2024-04-13T23:28:57Z |
| format | Article |
| id | doaj.art-6b2ff0476058450d92125f52e633b9ad |
| institution | Directory Open Access Journal |
| issn | 2331-5180 |
| language | English |
| last_indexed | 2025-03-20T23:38:01Z |
| publishDate | 2022-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Particle Therapy |
| spelling | doaj.art-6b2ff0476058450d92125f52e633b9ad2024-08-03T13:39:02ZengElsevierInternational Journal of Particle Therapy2331-51802022-07-01203010.14338/IJPT-22-00005.1i2331-5180-9-2-20Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation TherapyIrini Youssef, MD0Jennifer Yoon, MD1Nader Mohamed, BA2Kaveh Zakeri, MD3Robert H. Press, MD4Yao Yu, MD5Jung Julie Kang, MD, PhD6Richard J. Wong, MD7R. Michael Tuttle, MD8Ashok Shaha, MD9Eric Sherman, MD10Nancy Y. Lee, MD111 Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA2 Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA3 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA3 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA4 New York Proton Center, New York, NY, USA3 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA3 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA5 Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA6 Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, NY, USA5 Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA7 Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA3 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USAPurpose: Proton therapy is an emerging therapy for several malignancies owing to its favorable therapeutic ratio. There are very limited data on the use of proton therapy in the management of thyroid carcinoma. Our objective was to review the safety, feasibility, and outcomes of proton therapy for patients with thyroid cancer treated to the head and neck. Methods: From our institution's proton database from 2012 to 2021, we identified 22 patients with thyroid cancer treated with proton beam therapy. We evaluated outcomes and toxicities. Results: Median follow-up was 26 months. Of the 22 patients, 50% were female. The mean age was 65 years. Three patients had anaplastic cancer; 13, papillary carcinoma; 2, follicular carcinoma; and 2, poorly differentiated carcinoma. Forty-six percent had T4 disease. Primary targets were the central neck compartment, level VI, and upper mediastinum. Radiation dose was 60 GyRBE adjuvantly, and 70 GyRBE for gross disease (range, 6000-7600 GyRBE). Eight patients underwent upfront adjuvant radiation, and 3 received definitive radiation for unresectable disease upfront. Eleven patients received either salvage or palliative radiation. Fifty-nine percent of patients had extrathyroidal extension, and 64% of patients had gross disease in the neck before treatment. Fifty percent of patients had metastatic disease before treatment. Sixteen patients received concurrent chemotherapy, 63% of these patients received doxorubicin. For all patients, 1-year local regional recurrence (LRR) was 0%, and overall survival (OS) was 90%. Acute grade 3+ toxicities occurred in 27% of patients, the most frequent being dermatitis (27%). Three patients required a percutaneous endoscopic gastrostomy tube after radiation therapy (RT), 2 owing to progression. There were no grade 4+ toxicities. Conclusions: Proton therapy for thyroid cancer appears feasible and effective with minimal toxicities. Prospective studies comparing proton therapy with intensity-modulated RT, to evaluate the clinical efficacy of using proton therapy to reduce toxicities in patients undergoing radiation for thyroid cancer, are warranted.https://theijpt.org/doi/pdf/10.14338/IJPT-22-00005.1protonsnonmedullarythyroidtoxicitybragg peak |
| spellingShingle | Irini Youssef, MD Jennifer Yoon, MD Nader Mohamed, BA Kaveh Zakeri, MD Robert H. Press, MD Yao Yu, MD Jung Julie Kang, MD, PhD Richard J. Wong, MD R. Michael Tuttle, MD Ashok Shaha, MD Eric Sherman, MD Nancy Y. Lee, MD Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy International Journal of Particle Therapy protons nonmedullary thyroid toxicity bragg peak |
| title | Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy |
| title_full | Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy |
| title_fullStr | Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy |
| title_full_unstemmed | Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy |
| title_short | Outcomes and Toxicities of Nonmedullary Thyroid Tumors Treated with Proton Beam Radiation Therapy |
| title_sort | outcomes and toxicities of nonmedullary thyroid tumors treated with proton beam radiation therapy |
| topic | protons nonmedullary thyroid toxicity bragg peak |
| url | https://theijpt.org/doi/pdf/10.14338/IJPT-22-00005.1 |
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