Rapid Radiation Therapy for Advanced Cancer of the Head and Neck #336

Proton Beam Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma

Purpose

To discuss the role of proton beam therapy (PBT) in the treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC).

Materials and Methods

A review of the pertinent literature.

Results

Proton beam therapy likely results in reduced acute and late toxicity as compared with intensity-modulated radiation therapy (IMRT). The extent of the reduced toxicity, which may be modest, depends on the endpoint and technical factors such as pencil beam versus passive scattered PBT and adaptive replanning. The disease control rates after PBT are likely similar to those after IMRT.

Conclusion

Proton beam therapy is an attractive option to treat patients with OPSCC. Whether it becomes widely available depends on access.

Current Role of Radiotherapy in the Management of Oral Cavity Squamous Cell Carcinoma

Study Design

Literature review.

Objective

To review the current role of radiotherapy (RT) in the management of oral cavity squamous cell carcinoma (SCC).

Methods

Review of selected literature.

Results

T1-T2N0 SCCs may be treated with either RT alone or surgery with a high likelihood of cure. The pendulum swung toward surgery with postoperative RT (PORT) added depending on the pathological findings in the mid 1980s. Patients with positive margins, extranodal extension (ENE), and/or 4 or more positive nodes receive concomitant chemotherapy (POCRT). Patients with T3-T4 and/or positive regional nodes are treated with surgery and PORT alone or POCRT. The likelihood of cure is moderate to low depending on extent of disease. The likelihood of major complications ranges from 10% to 30% depending on the method of reconstruction and the aggressiveness of postoperative PORT/POCRT. Patients with very advanced disease are treated with palliative RT, chemotherapy, or supportive care.

Conclusions

The role of RT in the management of oral cavity SCC is primarily in the postoperative setting with palliative RT being reserved for those with very advanced disease where the likelihood of cure is remote.