For Young Patients With Head and Neck Sarcomas, Proton Therapy More Tolerable


Young patients with head and neck sarcoma treated with proton beam therapy had similar outcomes with less of an impact on quality of life as those treated with traditional photon radiation, according to a study recently published in Pediatric Blood and Cancer (doi: 10.1002/pbc.26858).

“These data show proton therapy is not only effective, it is also more tolerable for patients,” said Christine Hill-Kayser, MD, chief of the pediatric radiation oncology service at the University of Pennsylvania, study senior author, in a press release (October 23, 2017). “This study shows this treatment is safe and offers practice guidelines for delivering head and neck proton therapy in the pediatric population.”

Dr Hill-Kayser and colleagues treated 69 consecutive pediatric patients with head and neck cancer using proton beam therapy between 2010 and 2016. Post-operative radiation is often critical in such patients, since the complexity of the head and neck area can prevent surgeons from removing all the cancer. Among the patients in the study, 35 had rhabdomyosarcoma, 10 had Ewing sarcoma, and 24 had other cancers.

One year after treatment with proton beam therapy, 93% of patients were still living, researchers reported, and 92% did not experience recurrence at the primary disease site.

On a scale of 1 to 5 with 5 being the most severe, no patients experienced side effects higher than grade 3, according to the study. The most severe grade 3 toxicities were loss of appetite (22%), difficulty swallowing (7%), and mucositis (4%), in which ulcers form in the digestive tract.

“Different disease sites required different dosage levels,” said Jennifer Vogel, MD, co-lead author and resident in radiation oncology, in the press release. “We specifically found the severity of mucositis was associated with higher doses of radiation.”


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Still, the rate of side effects was still well below what is expected with traditional photon radiation, researchers said, pointing out that 46% of patients with rhabdomyosarcoma experience grade 3-4 mucositis.

Researchers plan to follow patients in the study to investigate long-term disease control and late-developing toxicity.—Jolynn Tumolo