The growing interest in proton therapy (PT) in recent decades is justified by the evidence that protons dose distribution allows maximal dose release at the tumor depth followed by sharp distal dose fall-off. But, in the holistic management of head and neck cancer (HNC), limiting the potential of PT to a mere dosimetric advantage appears reductive. Indeed, the precise targeting of PT may help evaluate the effectiveness of de-escalation strategies, especially for patients with human papillomavirus associated-oropharyngeal cancer (OPC) and nasopharyngeal cancer (NPC). Furthermore, PT could have potentially greater immunogenic effects than conventional photon therapy, possibly enhancing both the radiotherapy (RT) capability to activate anti-tumor immune response and the effectiveness of immunotherapy drugs. Based on these premises, the aim of the present paper is to conduct a narrative review reporting the safety and efficacy of PT compared to photon RT focusing on NPC and OPC. We also provide a snapshot of ongoing clinical trials comparing PT with photon RT for these two clinical scenarios. Finally, we discuss new insights that may further develop clinical research on PT for HNC.
近几十年来，质子治疗日益受到关注，其优势在于质子剂量分布能够在肿瘤深度实现最大剂量释放，并伴随陡峭的远端剂量跌落。然而，在头颈癌的整体治疗策略中，仅将质子治疗的潜力局限于剂量学优势显然是不够全面的。事实上，质子治疗的精准靶向特性有助于评估降级治疗策略的有效性，尤其对人乳头瘤病毒相关口咽癌和鼻咽癌患者而言。此外，与传统光子治疗相比，质子治疗可能具有更强的免疫原性效应，这既能增强放疗激活抗肿瘤免疫反应的能力，也可提升免疫治疗药物的疗效。基于以上背景，本文旨在通过叙述性综述，比较质子治疗与光子放疗在鼻咽癌和口咽癌治疗中的安全性和有效性。同时，我们概述了针对这两种临床场景比较质子治疗与光子放疗的正在进行中的临床试验。最后，我们探讨了可能推动头颈癌质子治疗临床研究进一步发展的新视角。
Current Status and Future Directions of Proton Therapy for Head and Neck Carcinoma
肿瘤(癌症)患者之家