Dr Garg on the Evolution of Proton Therapy in Head and Neck Cancer

“We started proton therapy mainly for certain tumors which are located in the base of the brain [and] for pediatric patients, but over the last five or six years it has evolved into more indications.”

Madhur K. Garg, MD, MBA, MBBS, the clinical director of radiation oncology, the co-director of the Stereotactic Radiosurgery Program, and a professor of radiation oncology and otolaryngology at Montefiore Medical Center, discussed the evolving role of proton therapy for the treatment of patients with head and neck cancer.

Proton therapy has become an increasingly important component of radiation oncology practice, with its use expanding considerably beyond the limited indications for which it was initially adopted, Garg began. He noted that he began using proton therapy nearly a decade ago through an agreement with the New Jersey Proton Center, allowing patients who were considered likely to benefit from the technology to receive treatment. More recently, treatment has been provided through the New York Proton Center in Manhattan, which has further expanded access to advanced proton therapy for patients in the region, he added.

Initially, proton therapy was used primarily for tumors in challenging anatomical locations where minimizing radiation exposure to surrounding critical structures was particularly important, Garg explained. One of the early applications included tumors located at the base of the brain, especially those situated close to critical nerves, he said. Pediatric patients also represented an important population because of the potential long-term consequences of radiation exposure to developing tissues, he noted.

Over approximately the past five to six years, however, the clinical applications of proton therapy have broadened significantly, Garg said. As additional research has emerged evaluating its safety, efficacy, and ability to limit radiation exposure to healthy tissue, proton therapy has been increasingly considered for a wider range of malignancies, he said. These include selected head and neck cancers, certain breast cancers, prostate cancers, and lung cancers, he explained.

The expanding evidence base is helping clarify which patients are most likely to benefit from proton therapy and where it may offer meaningful advantages over conventional radiation approaches, Garg said. Rather than being limited to a small group of highly specialized tumors, proton therapy is increasingly being incorporated into multidisciplinary cancer care when its physical dose-distribution advantages may improve treatment planning or reduce radiation exposure to nearby normal tissues, he concluded.