Proton Therapy for Head and Neck Cancer

Abstract

Treatment of localized cancer with protons therapy (PT) seems an appealing alternative to photons. PT has been available for decades and has unique dose distribution properties with the so-called Bragg-peak enabling protons to stop after their maximum depth is reached within millimeters. PT allows sparing of normal tissues and organs to a much greater extent than photons, even when modern photon techniques like intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) are involved. Whereas IMRT and VMAT techniques have demonstrated their superiority to older 3D-conformal irradiation techniques, there is still a large gap between the theoretical advantages of PT due to its superior dose distribution and high-level clinical evidence, particularly in head and neck cancer (HNC). So far, mostly non-randomized clinical studies exist with clinical results in oropharyngeal, nasopharyngeal, sinonasal, periorbital, and salivary gland cancer. The limited broad availability of this treatment method and its unknown cost-effectiveness need to be evaluated. In this chapter, we discuss the currently available evidence of PT for HNCs and viable options to generate further evidence like the model-based approach.