Nasal Cavity Malignancies: Charged Particle Therapy May Be Superior To Conventional Photon Therapy

Dr. Robert Foote MD Chair, Department of Radiation Oncology Mayo Clinic, Rochester, Interview with:
Dr. Robert Foote MD
Chair, Department of Radiation Oncology
Mayo Clinic, Rochester, MN

MedicalResearch: What are the main findings of the study?

Dr. Foote: Charged particle therapy (mainly protons and carbon ions) provide superior overall survival, disease-free survival and tumor control when compared to conventional photon therapy.  In particular, it appears that proton beam therapy provides superior disease-free survival and tumor control when compared to the state of the art intensity modulated radiation therapy using photons.

MedicalResearch: Were any of the findings unexpected?

Dr. Foote: Our hypothesis was that charged particle therapy would result in better tumor control and survival due to the ability to give a higher dose of radiation by taking advantage of the superior physical characteristics and dose distribution and perhaps increased radiobiologic effectiveness.  The evidence seems to support this hypothesis.  The risk for neurologic toxicity seemed to be higher with the use of charged particles.  This was somewhat unexpected because of the superior dose distribution achievable with charged particle therapy.  However, this may have been offset by using a higher dose of radiation therapy with charged particle therapy and perhaps scattered beam technology.  Unfortunately, there was inadequate information available related to radiation dose and dose distribution to evaluate this.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Foote: Patients with a variety of malignancies arising in the nasal cavity and/or paranasal sinuses who have indications for preoperative, postoperative or primary radiation therapy should be preferentially treated with charged particle therapy, including proton beam therapy, if at all possible.  Survival and tumor control appear to be improved with the use of charged particle therapy.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Foote: These types of malignancies in this location are relatively rare so it will be difficult to successfully complete a randomized controlled clinical trial comparing charged particles to photons.  Therefore, we would recommend that all institutions with charged particle therapy and/or intensity modulated radiation therapy enroll their patients on multi-institutional prospective registries or phase I/II clinical trials using standardized treatment protocols and collecting provider and patient reported outcomes using validated instruments to provide prospectively collected outcomes data for tumor control, survival, and acute and late toxicity.  Cost data should also be collected prospectively in order to perform cost effectiveness analyses.  Now that intensity modulated proton beam therapy is becoming more widely available, comparisons in outcomes should be made between scattered beam and intensity modulated proton beam therapy technology particularly with regard to neurologic toxicity.


Charged particle therapy versus photon therapy for paranasal sinus and nasal cavity malignant diseases: a systematic review and meta-analysis

Dr Samir H Patel MD,Zhen Wang PhD,William W Wong MD,Mohammad Hassan Murad MD,Courtney R Buckey PhD,Khaled Mohammed MBBCh,Fares Alahdab MD,Osama Altayar MD,Mohammed Nabhan MD,Steven E Schild MD,Robert L Foote MD
The Lancet Oncology – 27 June 2014
DOI: 10.1016/S1470-2045(14)70268-2


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