Proton Therapy Beneficial for Children with Head and Neck Cancers

Proton beam therapy (PBT) may be a better treatment option for pediatric patients with head and neck cancers than first-line therapy with traditional photon radiation, according to a new study published by Pediatric Blood and Cancer. The authors found that PBT results in similar outcomes with less of a detrimental impact on quality of life.
Head and neck cancers account for approximately 12% of pediatric cancers, but are vastly different than adult disease. With solid tumors—such as neuroblastoma, thyroid cancer, and soft tissue sarcomas—patients usually receive a combination of treatments, including drug therapy and surgery.
Due to the location of the tumors, treatments can greatly impact quality of life and may result in the loss of appetite, difficulty swallowing, or mucositis in response to chemotherapy or radiation, according to the authors.
“These concerns are especially important to address in pediatric patients, since they’re still developing and may need to deal with any adverse effects for the rest of their lives,” said senior author Christine Hill-Kayser, MD. “This study shows that protons may be an important tool in improving quality of life both during treatment and for years after for these young patients.”
In the study, the authors analyzed 69 cases of head and neck cancers among pediatric patients who were treated with PBT between 2010 and 2016. Half of the patients had rhabdomyosarcoma, while 7% had Ewing sarcoma. The remaining patients had a variety of other head and neck cancers.
These patients were observed to have similar disease control but lower rates of toxicity than traditional treatment, which highlights a potential new treatment option, according to the authors.
Approximately 93% of PBT-treated patients were still alive after 1 year, and 92% did not experience disease recurrence, according to the study.
Notably, the authors found that no patients experienced side effects that were above grade 3. The most severe toxicities were mucositis, loss of appetite and difficulty swallowing, according to the study. 
“Different disease sites required different dosage levels, and we specifically found the severity of mucositis was associated with higher doses of radiation,” Dr Vogel said.
The authors note that the rate of adverse events for PBT were significantly below those observed with photon radiation. Historically, approximately 46% of patients with rhabdomyosarcoma experience grade 3 or 4 mucositis compared with only 4% of PBT-treated patients, according to the study.
The authors plan to evaluate long-term disease control and toxicity among these patients to examine the potential benefits of PBT over traditional therapy.
“These data show proton therapy is not only effective, it is also more tolerable for patients,” Dr Hill-Kayser said. “This study shows this treatment is safe and offers practice guidelines for delivering head and neck proton therapy in the pediatric population.”

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