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

“[Patient] quality of life is better [with proton therapy], including an improvement in overall survival in the long run. I am very optimistic [and] I think most patients with head and neck cancer who [are treated with] radiation are going to benefit from proton therapy.”

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 safety profile of proton therapy for the treatment of patients with head and neck cancer.

Head and neck cancers present a unique challenge in radiation oncology because numerous critical structures in the region are highly sensitive to radiation, Garg began. The parotid glands are particularly vulnerable, and exposure above certain radiation doses can result in significant dryness of the mouth, he noted. Other sensitive structures include the muscles involved in swallowing, making efforts to minimize unnecessary radiation exposure especially important when treating tumors in this region, he said.

Despite these concerns, radiation therapy remains a highly effective treatment for head and neck cancers, Garg emphasized. For many patients, radiation can provide a high likelihood of controlling the cancer while allowing them to avoid extensive and potentially disfiguring surgery, he said. As a result, radiation plays a central role in the management of many head and neck malignancies, he noted. However, treatment-related toxicities, particularly xerostomia, have historically limited its effect on patient quality of life (QOL), he added.

Proton therapy may help address some of these challenges by reducing radiation exposure to surrounding healthy structures, Garg explained. Emerging evidence has demonstrated improved QOL among patients treated with proton therapy, consistent with the potential benefits of limiting radiation to sensitive tissues, he said. QOL improvements have been associated with an overall survival benefit, suggesting that the advantages of proton therapy may extend beyond reducing treatment-related toxicity, he concluded.