Systematic review and meta-analysis of radiotherapy in various head and neck cancers: Comparing photons, carbon-ions and protons

Bram L. T. Ramaekers*, Madelon Pijls-Johannesma, Manuela A. Joore, Piet van den Ende, Johannes A. Langendijk, Philippe Lambin, Alfons G. H. Kessels, Janneke P. C. Grutters

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

58 Citations (Scopus)

Abstract

Purpose: To synthesize and compare available evidence considering the effectiveness of carbon-ion, proton and photon radiotherapy for head and neck cancer.

Methods: A systematic review and meta-analyses were performed to retrieve evidence on tumor control, survival and late treatment toxicity for carbon-ion, proton and the best available photon radiotherapy.

Results: In total 86 observational studies (74 photon, 5 carbon-ion and 7 proton) and eight comparative in-silico studies were included. For mucosal malignant melanomas, 5-year survival was significantly higher after carbon-ion therapy compared to conventional photon therapy (44% versus 25%; P-value 0.007). Also, 5-year local control after proton therapy was significantly higher for paranasal and sinonasal cancer compared to intensity modulated photon therapy (88% versus 66%; P-value 0.035). No other statistically significant differences were observed. Although poorly reported, toxicity tended to be less frequent in carbon-ion and proton studies compared to photons.

In-silico studies showed a lower dose to the organs at risk, independently of the tumor site.

Conclusions: For carbon-ion therapy, the increased survival in mucosal malignant melanomas might suggest an advantage in treating relatively radio-resistant tumors. Except for paranasal and sinonasal cancer, survival and tumor control for proton therapy were generally similar to the best available photon radiotherapy. In agreement with included in-silico studies, limited available clinical data indicates that toxicity tends to be lower for proton compared to photon radiotherapy.

Since the overall quantity and quality of data regarding carbon-ion and proton therapy is poor, we recommend the construction of an international particle therapy register to facilitate definitive comparisons. (C) 2010 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)185-201
Number of pages17
JournalCANCER TREATMENT REVIEWS
Volume37
Issue number3
DOIs
Publication statusPublished - May-2011

Keywords

  • Radiotherapy
  • Photon
  • IMRT
  • Particle
  • Carbon-ion
  • Proton
  • Head and neck cancer
  • Meta-analysis
  • Systematic review
  • ADENOID CYSTIC CARCINOMA
  • INTENSITY-MODULATED RADIOTHERAPY
  • QUALITY-OF-LIFE
  • SQUAMOUS-CELL CARCINOMA
  • ADVANCED NASOPHARYNGEAL CARCINOMA
  • ADVANCED SINONASAL MALIGNANCIES
  • ADJUVANT RADIATION-THERAPY
  • CURRENT CLINICAL-EVIDENCE
  • PRIMARY MUCOSAL MELANOMA
  • PARANASAL SINUSES

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