Proton Therapy Radiation: Decreased Need for Feeding Tubes in Oropharnygeal Cancer Patients

Steven J. Frank, M.D., associate professor of Radiation Oncology at The University of Texas MD Anderson Proton Therapy Interview with:

Steven J. Frank, M.D., associate professor of Radiation Oncology at The University of Texas MD Anderson Proton Therapy Center discusses the findings of his latest study, “Gastrostomy Tubes Decrease by Over 50% with Intensity Modulated Proton Therapy during the Treatment of Oropharyngeal Cancer Patients.” What are the main findings of the study?

Dr. Frank: The study found that the use of feeding tubes in oropharyngeal carcinoma (OPC) cancer patients treated with intensity modulated proton therapy (IMPT) decreased by more than 50% percent compared to patients treated with intensity modulated radiation therapy (IMRT). This suggests that proton therapy may offer vital quality of life benefits for patients with tumors occurring at the back of the throat.

Of the 50 OPC patients enrolled in the study:

  • Twenty-five patients were treated with IMPT and 25 received IMRT.
  • Five patients treated with IMPT required the use of feeding tubes (20%) compared to 12 patients treated with IMRT (48%).
  • IMPT patients were spared from serious side effects, usually a result of IMRT, such as loss of taste, vomiting, nausea, pain, mouth and tongue ulcers, dry mouth, fatigue, and swallowing difficulty.
  • IMPT patients could better sustain their nutrition and hydration levels, often leading to faster recovery during and after treatment.

IMPT is an advanced form of proton radiation therapy and a treatment currently only offered in North America at The University of Texas MD Anderson Proton Therapy Center. It delivers protons to the most complicated tumors by focusing a narrow proton beam and essentially “painting” the radiation dose onto the tumor layer by layer. Unlike IMRT, which destroys both cancerous and healthy cells, IMPT has the ability to destroy cancer cells while sparing surrounding healthy tissue from damage. Therefore, important quality of life outcomes such as neurocognitive function, vision, swallowing, hearing, taste and speech can be preserved in head and neck patients. Were any of the findings unexpected?

Dr. Frank: It is known that using IMPT vs. IMRT in this critical head and neck area achieves less radiation dose to the surrounding tissues. What the study found was that the low doses of radiation therapy have truly measurable acute effects and the feeding tube rate in itself is simply a metric of the symptom burden that is infused by all the additional radiation of IMRT. However, the fact that the feeding tube rate in IMPT patients was reduced by over 50% was very surprising.

This finding guided MD Anderson to initiate a Phase II/III randomized trial to truly better appreciate if the reduction of feeding tubes by 50% is a replicable finding that will perhaps change the standard of care (more details below). What should clinicians and patients take away from this report?

Dr. Frank: Clinicians and patients should realize that HPV associated head and neck tumors are rising in epidemic proportions in the United States and most patients are young, non-drinkers and non-smokers.   Patients with HPV+ tumors will likely be cured and efforts are underway to reduce the toxicity of the treatment. Proton therapy might offer another tool to provide one measurable solution, and, in addition, since it reduces the toxicity, it can potentially increase patient’s quality of life both during and after treatment.

The clinicians should realize that there are new capabilities at their disposal for head and neck patients with proton therapy treatment.

Patients should be aware that proton therapy may effectively treat their head and neck cancer while decreasing the toxicity that will allow the patients to continue to work and function during and after treatment. What recommendations do you have for future research as a result of this study?

Dr. Frank: More studies are needed to better understand how improving the delivery of radiation therapy, the main tool to treat OPC in this fairly young group of patients, can provide additional value to those afflicted with HPV associated head and neck cancer. Based on the results of this study, a Phase II/III randomized trial of IMPT vs. IMRT for the treatment of advanced stage oropharyngeal cancer of the head and neck is underway at MD Anderson. Over the next five years, the trial will enroll up to 400 patients. This randomized trial will aim to demonstrate that proton therapy can improve treatment outcomes in a cost effective manner.


Gastrostomy Tubes Decrease by Over 50% With Intensity Modulated Proton Therapy (IMPT) During the Treatment of Oropharyngeal Cancer Patients: A Case–Control Study

S.J. Frank, D.I. Rosenthal, K. Ang, E.M. Sturgis, M.S. Chambers, G.B. Gunn, K.A. Hutcheson, X.R. Zhu, M.B. Palmer, A.S. Garden

International Journal of Radiation Oncology * Biology * Physics – 1 October 2013 (Vol. 87, Issue 2, Supplement, Page S144, DOI: 10.1016/j.ijrobp.2013.06.371)



Last Updated on March 1, 2015 by Marie Benz MD FAAD