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[Proton therapy for head and neck squamous cell carcinomas: From physics to clinic].

Authors
  • Beddok, A1
  • Vela, A2
  • Calugaru, V1
  • Tessonnier, T2
  • Kubes, J3
  • Dutheil, P2
  • Gérard, A4
  • Vidal, M4
  • Goudjil, F1
  • Florescu, C2
  • Kammerer, E2
  • Bénézery, K4
  • Hérault, J4
  • Bourhis, J5
  • Thariat, J6
  • 1 Département d'oncologie-radiothérapie, institut Curie, 25, rue d'Ulm, 75005 Paris, France. , (France)
  • 2 Département d'oncologie-radiothérapie, centre François-Baclesse, Caen, 3, avenue du Général-Harris, 14000 Caen, France; Unicaen - Normandie Université, 14000 Caen, France; Advanced Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue du Général-Harris, 14000 Caen, France. , (France)
  • 3 Proton Therapy Centre Czech, Prague, République tchèque.
  • 4 Centre Antoine-Lacassagne, département d'oncologie-radiothérapie, 33, avenue Valombrose, 06000 Nice, France. , (France)
  • 5 Département d'oncologie-radiothérapie, centre hospitalier universitaire vaudois, Lausanne, Suisse.
  • 6 Département d'oncologie-radiothérapie, centre François-Baclesse, Caen, 3, avenue du Général-Harris, 14000 Caen, France; Unicaen - Normandie Université, 14000 Caen, France; Advanced Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue du Général-Harris, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/Ensicaen - UMR6534, Unicaen - Normandie Université, 14000 Caen, France. Electronic address: [email protected] , (France)
Type
Published Article
Journal
Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique
Publication Date
Jul 26, 2019
Identifiers
DOI: 10.1016/j.canrad.2019.05.015
PMID: 31358445
Source
Medline
Keywords
Language
French
License
Unknown

Abstract

Intensity-modulated radiation therapy (IMRT) is presently the recommended technique for the treatment of locally advanced head and neck carcinomas. Proton therapy would allow to reduce the volume of irradiated normal tissue and, thus, to decrease the risk of late dysphagia, xerostomia, dysgeusia and hypothyroidism. An exhaustive research was performed with the search engine PubMed by focusing on the papers about the physical difficulties that slow down use of proton therapy for head and neck carcinomas. Range uncertainties in proton therapy (±3 %) paradoxically limit the use of the steep dose gradient in distality. Calibration uncertainties can be important in the treatment of head and neck cancer in the presence of materials of uncertain stoichiometric composition (such as with metal implants, dental filling, etc.) and complex heterogeneities. Dental management for example may be different with IMRT or proton therapy. Some uncertainties can be somewhat minimized at the time of optimization. Inter- and intrafractional variations and uncertainties in Hounsfield units/stopping power can be integrated in a robust optimization process. Additional changes in patient's anatomy (tumour shrinkage, changes in skin folds in the beam patch, large weight loss or gain) require rescanning. Dosimetric and small clinical studies comparing photon and proton therapy have well shown the interest of proton therapy for head and neck cancers. Intensity-modulated proton therapy is a promising treatment as it can reduce the substantial toxicity burden of patients with head and neck squamous cell carcinoma compared to IMRT. Robust optimization will allow to perform an optimal treatment and to use proton therapy in current clinical practice. Copyright © 2019 Société française de radiothérapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

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