Systematic review and meta-analysis of radiotherapy in various head and neck cancers: Comparing photons, carbon-ions and protons

• Published in: Cancer treatment reviews Vol. 37; no. 3; pp. 185 - 201
• Main Authors: Ramaekers, Bram L.T, Pijls-Johannesma, Madelon, Joore, Manuela A, van den Ende, Piet, Langendijk, Johannes A, Lambin, Philippe, Kessels, Alfons G.H, Grutters, Janneke P.C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2011
• Subjects: Carbon - therapeutic use; Carbon-ion; Head and neck cancer; Head and Neck Neoplasms - radiotherapy; Hematology, Oncology and Palliative Medicine; Humans; IMRT; Ions - therapeutic use; Meta-analysis; Particle; Photon; Photons - therapeutic use; Proton; Protons - therapeutic use; Radiotherapy; Radiotherapy - methods; Systematic review; Particle; IMRT; Carbon-ion; Proton; Head and neck cancer; Systematic review; Radiotherapy; Photon; Meta-analysis
• ISSN: 0305-7372; 1532-1967
• DOI: 10.1016/j.ctrv.2010.08.004

Abstract Purpose To synthesize and compare available evidence considering the effectiveness of carbon-ion, proton and photon radiotherapy for head and neck cancer. Methods A systematic review and meta-analyses were performed to retrieve evidence on tumor control, survival and late treatment toxicity for carbon-ion, proton and the best available photon radiotherapy. Results In total 86 observational studies (74 photon, 5 carbon-ion and 7 proton) and eight comparative in-silico studies were included. For mucosal malignant melanomas, 5-year survival was significantly higher after carbon-ion therapy compared to conventional photon therapy (44% versus 25%; P -value 0.007). Also, 5-year local control after proton therapy was significantly higher for paranasal and sinonasal cancer compared to intensity modulated photon therapy (88% versus 66%; P -value 0.035). No other statistically significant differences were observed. Although poorly reported, toxicity tended to be less frequent in carbon-ion and proton studies compared to photons. In-silico studies showed a lower dose to the organs at risk, independently of the tumor site. Conclusions For carbon-ion therapy, the increased survival in mucosal malignant melanomas might suggest an advantage in treating relatively radio-resistant tumors. Except for paranasal and sinonasal cancer, survival and tumor control for proton therapy were generally similar to the best available photon radiotherapy. In agreement with included in-silico studies, limited available clinical data indicates that toxicity tends to be lower for proton compared to photon radiotherapy. Since the overall quantity and quality of data regarding carbon-ion and proton therapy is poor, we recommend the construction of an international particle therapy register to facilitate definitive comparisons.