International Journal of Particle Therapy最新文献

{"title":"Proton Beam Therapy for Head and Neck Carcinoma of Unknown Primary: Toxicity and Quality of Life.","authors":"Alexander D Sherry,&nbsp;Dario Pasalic,&nbsp;G Brandon Gunn,&nbsp;C David Fuller,&nbsp;Jack Phan,&nbsp;David I Rosenthal,&nbsp;William H Morrison,&nbsp;Erich M Sturgis,&nbsp;Neil D Gross,&nbsp;Maura L Gillison,&nbsp;Renata Ferrarotto,&nbsp;Adel K El-Naggar,&nbsp;Adam S Garden,&nbsp;Steven J Frank","doi":"10.14338/IJPT-20-00034.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00034.1","url":null,"abstract":"<p><strong>Purpose: </strong>Proton radiation therapy (PRT) may offer dosimetric and clinical benefit in the treatment of head and neck carcinoma of unknown primary (HNCUP). We sought to describe toxicity and quality of life (QOL) in patients with HNCUP treated with PRT.</p><p><strong>Patients and methods: </strong>Toxicity and QOL were prospectively tracked in patients with HNCUP from 2011 to 2019 after institutional review board approval. Patients received PRT to the mucosa of the nasopharynx, oropharynx, and bilateral cervical lymph nodes with sparing of the larynx and hypopharynx. Patient-reported outcomes were tracked with the MD Anderson Symptom Inventory-Head and Neck Module, the Functional Assessment of Cancer Therapy-Head and Neck, the MD Anderson Dysphagia Inventory, and the Xerostomia-Related QOL Scale. Primary study endpoints were the incidence of grade ≥ 3 (G3) toxicity and QOL patterns.</p><p><strong>Results: </strong>Fourteen patients (median follow-up, 2 years) were evaluated. Most patients presented with human papillomavirus-positive disease (n = 12, 86%). Rates of G3 oral mucositis, xerostomia, and dermatitis were 7% (n = 1), 21% (n = 3), and 36% (n = 5), respectively. None required a gastrostomy. During PRT, QOL was reduced relative to baseline and recovered shortly after PRT. At 2 years after PRT, the local regional control, disease-free survival, and overall survival were 100% (among 7 patients at risk), 79% (among 6 patients at risk), and 90% (among 7 patients at risk), respectively.</p><p><strong>Conclusion: </strong>Therefore, PRT for HNCUP was associated with highly favorable dosimetric and clinical outcomes, including minimal oral mucositis, xerostomia, and dysphagia. Toxicity and QOL may be superior with PRT compared with conventional radiation therapy and PRT maintains equivalent oncologic control. Further prospective studies are needed to evaluate late effects and cost-effectiveness.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"234-247"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of the Robust Optimization Process and Advances with Monte Carlo in the Proton Therapy Management of Head and Neck Tumors.","authors":"Xiaodong Zhang","doi":"10.14338/IJPT-20-00078.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00078.1","url":null,"abstract":"<p><p>In intensity-modulated proton therapy, robust optimization processes have been developed to manage uncertainties associated with (1) range, (2) setup, (3) anatomic changes, (4) dose calculation, and (5) biological effects. Here we review our experience using a robust optimization technique that directly incorporates range and setup uncertainties into the optimization process to manage those sources of uncertainty. We also review procedures for implementing adaptive planning to manage the anatomic uncertainties. Finally, we share some early experiences regarding the impact of uncertainties in dose calculation and biological effects, along with techniques to manage and potentially reduce these uncertainties.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"14-24"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovations and the Use of Collimators in the Delivery of Pencil Beam Scanning Proton Therapy.","authors":"Daniel E Hyer,&nbsp;Laura C Bennett,&nbsp;Theodore J Geoghegan,&nbsp;Martin Bues,&nbsp;Blake R Smith","doi":"10.14338/IJPT-20-00039.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00039.1","url":null,"abstract":"<p><strong>Purpose: </strong>The development of collimating technologies has become a recent focus in pencil beam scanning (PBS) proton therapy to improve the target conformity and healthy tissue sparing through field-specific or energy-layer-specific collimation. Given the growing popularity of collimators for low-energy treatments, the purpose of this work was to summarize the recent literature that has focused on the efficacy of collimators for PBS and highlight the development of clinical and preclinical collimators.</p><p><strong>Materials and methods: </strong>The collimators presented in this work were organized into 3 categories: per-field apertures, multileaf collimators (MLCs), and sliding-bar collimators. For each case, the system design and planning methodologies are summarized and intercompared from their existing literature. Energy-specific collimation is still a new paradigm in PBS and the 2 specific collimators tailored toward PBS are presented including the dynamic collimation system (DCS) and the Mevion Adaptive Aperture.</p><p><strong>Results: </strong>Collimation during PBS can improve the target conformity and associated healthy tissue and critical structure avoidance. Between energy-specific collimators and static apertures, static apertures have the poorest dose conformity owing to collimating only the largest projection of a target in the beam's eye view but still provide an improvement over uncollimated treatments. While an external collimator increases secondary neutron production, the benefit of collimating the primary beam appears to outweigh the risk. The greatest benefit has been observed for low- energy treatment sites.</p><p><strong>Conclusion: </strong>The consensus from current literature supports the use of external collimators in PBS under certain conditions, namely low-energy treatments or where the nominal spot size is large. While many recent studies paint a supportive picture, it is also important to understand the limitations of collimation in PBS that are specific to each collimator type. The emergence and paradigm of energy-specific collimation holds many promises for PBS proton therapy.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"73-83"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Proton Therapy for the Management of Nasopharyngeal Cancer.","authors":"Anna Lee,&nbsp;Sarin Kitpanit,&nbsp;Marina Chilov,&nbsp;Johannes A Langendijk,&nbsp;Jiade Lu,&nbsp;Nancy Y Lee","doi":"10.14338/IJPT-20-00082.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00082.1","url":null,"abstract":"<p><strong>Purpose: </strong>With improved technology, more patients with nasopharyngeal cancer (NPC) are receiving definitive treatment with proton therapy, which allows greater sparing of dose to normal tissues without compromising efficacy. As there is no randomized data, the purpose of this study was to systematically review the available literature on proton therapy in this setting, focusing on the toxicity endpoints.</p><p><strong>Materials and methods: </strong>A systematic search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in 5 databases: PubMed, Embase, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials. A total of 491 studies were found on the topic of NPC and proton therapy. Following independent study selection by 2 investigators, 9 studies were found to have sufficient focus and relevance to be incorporated into the systematic review.</p><p><strong>Results: </strong>All 9 studies were retrospective and examined only NPC patients except for one that also included paranasal sinus cancer. One study was a reirradiation study. Four studies used 3D or double scatter technique, while all others used intensity-modulated proton therapy. Oncologic outcomes were similar to intensity-modulated radiation therapy (IMRT) rates, with 2-year local and regional progression-free survival (LRFS) ranging from 84% to 100%, 2-year progression-free survival (PFS) ranging from 75% to 88.9%, and 2-year overall survival (OS) ranging from 88% to 95% in the up-front setting. Four comparison studies with IMRT found significantly lower feeding tube rates (20% versus 65%, <i>P</i> = .015; and 14% versus 85%, <i>P</i> < .001) with proton therapy as well as lower mucositis (G2 46% versus 70%, <i>P</i> = .019; and G3 11% versus 76%, <i>P</i> = .0002). All other acute and late effects were largely improved with proton therapy but not statistically significant.</p><p><strong>Conclusions: </strong>NPC patients receiving proton therapy maintain good outcomes with improved toxicity profile, likely due to sparing of dose to normal structures. Prospective studies are ongoing to better quantify the magnitude.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"119-130"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39204500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton Therapy for Major Salivary Gland Cancer: Clinical Outcomes.","authors":"Alexander N Hanania,&nbsp;Xiaodong Zhang,&nbsp;G Brandon Gunn,&nbsp;David I Rosenthal,&nbsp;Adam S Garden,&nbsp;C David Fuller,&nbsp;Jack Phan,&nbsp;Jay P Reddy,&nbsp;Amy Moreno,&nbsp;Gregory Chronowski,&nbsp;Shalin Shah,&nbsp;Noveen Ausat,&nbsp;Ehab Hanna,&nbsp;Renata Ferrarotto,&nbsp;Steven J Frank","doi":"10.14338/IJPT-20-00044.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00044.1","url":null,"abstract":"<p><strong>Purpose: </strong>To report clinical outcomes in terms of disease control and toxicity in patients with major salivary gland cancers (SGCs) treated with proton beam therapy.</p><p><strong>Materials and methods: </strong>Clinical and dosimetric characteristics of patients with SGCs treated from August 2011 to February 2020 on an observational, prospective, single-institution protocol were abstracted. Local control and overall survival were calculated by the Kaplan-Meier method. During radiation, weekly assessments of toxicity were obtained, and for patients with ≥ 90 days of follow-up, late toxicity was assessed.</p><p><strong>Results: </strong>Seventy-two patients were identified. Median age was 54 years (range, 23-87 years). Sixty-three patients (88%) received postoperative therapy, and nine patients (12%) were treated definitively. Twenty-six patients (36%) received concurrent chemotherapy. Nine patients (12%) had received prior radiation. All (99%) but one patient received unilateral treatment with a median dose of 64 GyRBE (relative biological effectiveness) (interquartile range [IQR], 60-66), and 53 patients (74%) received intensity-modulated proton therapy with either single-field or multifield optimization. The median follow-up time was 30 months. Two-year local control and overall survival rates were 96% (95% confidence interval [CI] 85%-99%) and 89% (95% CI 76%-95%], respectively. Radiation dermatitis was the predominant grade-3 toxicity (seen in 21% [n = 15] of the patients), and grade ≥ 2 mucositis was rare (14%; n = 10 patients). No late-grade ≥ 3 toxicities were reported.</p><p><strong>Conclusion: </strong>Proton beam therapy for treatment of major SGCs manifests in low rates of acute mucosal toxicity. In addition, the current data suggest a high rate of local control and minimal late toxicity.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"261-272"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Critical Review of LET-Based Intensity-Modulated Proton Therapy Plan Evaluation and Optimization for Head and Neck Cancer Management.","authors":"Wei Deng,&nbsp;Yunze Yang,&nbsp;Chenbin Liu,&nbsp;Martin Bues,&nbsp;Radhe Mohan,&nbsp;William W Wong,&nbsp;Robert H Foote,&nbsp;Samir H Patel,&nbsp;Wei Liu","doi":"10.14338/IJPT-20-00049.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00049.1","url":null,"abstract":"<p><p>In this review article, we review the 3 important aspects of linear-energy-transfer (LET) in intensity-modulated proton therapy (IMPT) for head and neck (H&N) cancer management. Accurate LET calculation methods are essential for LET-guided plan evaluation and optimization, which can be calculated either by analytical methods or by Monte Carlo (MC) simulations. Recently, some new 3D analytical approaches to calculate LET accurately and efficiently have been proposed. On the other hand, several fast MC codes have also been developed to speed up the MC simulation by simplifying nonessential physics models and/or using the graphics processor unit (GPU)-acceleration approach. Some concepts related to LET are also briefly summarized including (1) dose-weighted versus fluence-weighted LET; (2) restricted versus unrestricted LET; and (3) microdosimetry versus macrodosimetry. LET-guided plan evaluation has been clinically done in some proton centers. Recently, more and more studies using patient outcomes as the biological endpoint have shown a positive correlation between high LET and adverse events sites, indicating the importance of LET-guided plan evaluation in proton clinics. Various LET-guided plan optimization methods have been proposed to generate proton plans to achieve biologically optimized IMPT plans. Different optimization frameworks were used, including 2-step optimization, 1-step optimization, and worst-case robust optimization. They either indirectly or directly optimize the LET distribution in patients while trying to maintain the same dose distribution and plan robustness. It is important to consider the impact of uncertainties in LET-guided optimization (ie, LET-guided robust optimization) in IMPT, since IMPT is sensitive to uncertainties including both the dose and LET distributions. We believe that the advancement of the LET-guided plan evaluation and optimization will help us exploit the unique biological characteristics of proton beams to improve the therapeutic ratio of IMPT to treat H&N and other cancers.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"36-49"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Particle Therapy in Adenoid Cystic Carcinoma and Mucosal Melanoma of the Head and Neck.","authors":"Daniel K Ebner,&nbsp;Timothy D Malouff,&nbsp;Steven J Frank,&nbsp;Masashi Koto","doi":"10.14338/IJPT-D-20-00076","DOIUrl":"https://doi.org/10.14338/IJPT-D-20-00076","url":null,"abstract":"<p><p>Particle irradiation is suitable for resistant histologies owing to a combination of improved dose delivery with potential radiobiologic advantages in high linear energy transfer radiation. Within the head and neck, adenoid cystic carcinoma and mucosal melanoma are two such histologies, being radioresistant and lying closely proximal to critical structures. Here, we review the use of particle irradiation for adenoid cystic carcinoma and mucosal melanoma of the head and neck.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"273-284"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Passively Scattered Proton Therapy for Nonmelanoma Skin Cancer with Clinical Perineural Invasion.","authors":"Curtis M Bryant,&nbsp;Roi Dagan,&nbsp;Adam L Holtzman,&nbsp;Rui Fernandes,&nbsp;Anthony Bunnell,&nbsp;William M Mendenhall","doi":"10.14338/IJPT-20-00062.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00062.1","url":null,"abstract":"<p><strong>Purpose: </strong>To report our experience with the delivery of passively scattered proton therapy in the management of nonmelanoma skin cancers with clinical perineural invasion.</p><p><strong>Materials and methods: </strong>We reviewed the medical records of patients who received definitive or postoperative proton therapy for nonmelanoma skin cancer with clinical perineural invasion at our institution and updated patient follow-up when possible. All patients were treated with curative intent with or without the delivery of concurrent systemic therapy. We report disease control rates and the rates of late toxicity among this cohort.</p><p><strong>Results: </strong>Twenty-six patients treated between 2008 and 2017 were included in the analysis. Following proton therapy, the 3-year overall, cause-specific, and disease-free survival rates were 59%, 73%, and 60%, respectively. The 3-year local control, local regional control, and distant metastasis-free survival rates were 80%, 65%, and 96%, respectively. On univariate analysis, surgical resection before radiation therapy significantly improved local regional control rates at 3 years (55% versus 86%; <i>P</i> = .04). Grade 3+ late toxicities occurred in 13 patients (50%) and the most common toxicities included grade 3+ keratitis of the ipsilateral eye, which occurred in 4 patients (15%) and grade 3+ brain necrosis in 4 patients (15%).</p><p><strong>Conclusion: </strong>Proton therapy is effective in the management of nonmelanoma skin cancer with clinical perineural invasion. Although disease control and complication rates compare favorably to those previously published for photon-based radiation therapy, the risk for late toxicity is significant and patients should be appropriately counseled.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"285-293"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton Radiotherapy to Reduce Late Complications in Childhood Head and Neck Cancers.","authors":"Michael T Spiotto,&nbsp;Susan L McGovern,&nbsp;G Brandon Gunn,&nbsp;David Grosshans,&nbsp;Mary Frances McAleer,&nbsp;Steven J Frank,&nbsp;Arnold C Paulino","doi":"10.14338/IJPT-20-00069.1","DOIUrl":"https://doi.org/10.14338/IJPT-20-00069.1","url":null,"abstract":"<p><p>In most childhood head and neck cancers, radiotherapy is an essential component of treatment; however, it can be associated with problematic long-term complications. Proton beam therapy is accepted as a preferred radiation modality in pediatric cancers to minimize the late radiation side effects. Given that childhood cancers are a rare and heterogeneous disease, the support for proton therapy comes from risk modeling and a limited number of cohort series. Here, we discuss the role of proton radiotherapy in pediatric head and neck cancers with a focus on reducing radiation toxicities. First, we compare the efficacy and expected toxicities in proton and photon radiotherapy for childhood cancers. Second, we review the benefit of proton radiotherapy in reducing acute and late radiation toxicities, including risks for secondary cancers, craniofacial development, vision, and cognition. Finally, we review the cost effectiveness for proton radiotherapy in pediatric head and neck cancers. This review highlights the benefits of particle radiotherapy for pediatric head and neck cancers to improve the quality of life in cancer survivors, to reduce radiation morbidities, and to maximize efficient health care use.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"155-167"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39204502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spot Scanning Proton Therapy for Sinonasal Malignant Tumors.","authors":"Koichiro Nakajima,&nbsp;Hiromitsu Iwata,&nbsp;Yukiko Hattori,&nbsp;Kento Nomura,&nbsp;Shingo Hashimoto,&nbsp;Toshiyuki Toshito,&nbsp;Kensuke Hayashi,&nbsp;Yo Kuroda,&nbsp;Hideo Fukano,&nbsp;Hiroyuki Ogino,&nbsp;Yuta Shibamoto","doi":"10.14338/IJPT-D-20-00043.1","DOIUrl":"https://doi.org/10.14338/IJPT-D-20-00043.1","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment of sinonasal malignant tumors is challenging, and evidence to establish a standard treatment is limited. Our objective was to evaluate the efficacy and safety of spot scanning proton therapy (SSPT) for sinonasal malignant tumors.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed patients with sinonasal malignant tumors (T1-4bN0-2M0) who underwent SSPT between May 2014 and September 2019. The prescription dose was typically either 60 GyRBE in 15 fractions or 60.8 GyRBE in 16 fractions for mucosal melanoma and 70.2 GyRBE in 26 fractions for other histologic subtypes. Endpoints included local control (LC), progression-free survival, overall survival (OS), and incidence of toxicity. Prognostic factors were analyzed using the Kaplan-Meier method and log-rank test.</p><p><strong>Results: </strong>Of 62 enrolled patients, the common histologic subtypes were mucosal melanoma (35%), squamous cell carcinoma (27%), adenoid cystic carcinoma (16%), and olfactory neuroblastoma (10%). Locally advanced stages were common (T3 in 42% and T4 in 53%). Treatment-naïve tumors and postsurgical recurrent tumors accounted for 73% and 27%, respectively. No patient had previous radiotherapy. The median follow-up was 17 months (range, 6-66) for all patients and 21.5 months (range, 6-66) for survivors. The 2-year LC, progression-free survival, and OS rates of all patients were 92%, 50%, and 76%, respectively. Univariate analysis revealed histology as a prognostic factor for OS, being higher in adenoid cystic carcinoma and olfactory neuroblastoma than in other tumors. Sixteen grade ≥3 late toxicities were observed in 12 patients (19%), including 11 events resulting in visual impairment; the most common was cataract. There was 1 grade 4 toxicity, and there were no grade 5 toxicities.</p><p><strong>Conclusion: </strong>SSPT was well tolerated and yielded good LC for sinonasal malignant tumors. Although we consider SSPT to be a leading treatment modality, further studies are required to establish its status as a standard treatment.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":" ","pages":"189-199"},"PeriodicalIF":1.7,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39204505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}