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

*Bijbehorende auteur voor dit werk

Onderzoeksoutputpeer review

69 Citaten (Scopus)


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.

Originele taal-2English
Pagina's (van-tot)185-201
Aantal pagina's17
Nummer van het tijdschrift3
StatusPublished - mei-2011

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