What is oropharyngeal cancer
By Christina L. Mershell
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Study Shows Proton Beam Therapy as a Standard of Care for the Disease Oropharyngeal Cancer
Oropharyngeal cancer, the most common head and neck cancer in the United States, is a malignant tumor of the tonsil, soft palate and/or base of tongue. While cancers of the head and neck only account for approximately 4% of all cancers in the United States1, they are subject to intense study because many of the currently available treatments cause significant side effects.
Oropharyngeal cancer can be caused by tobacco abuse, alcohol abuse, genetics or infection with the human papillomavirus (HPV)2. Over the last 20 years, HPV has become the most common cause of this cancer among Americans. Current treatments for oropharyngeal cancer include surgery, radiation therapy and chemotherapy. Receiving these treatments can affect a person’s ability to eat, drink and speak normally. These compilations can have a high impact on daily quality of life for many patients with oropharyngeal cancer.
Treating Oropharyngeal Cancer
Due to the impact on quality of life, it is important to find ways to treat head and neck cancers without causing such excessive side effects, while still providing a curative treatment.
One exciting new study was presented at the 2024 American Society of Clinical Oncology (ASCO) Annual meeting and published in the Journal of Clinical Oncology. This study is titled: “Phase III randomized trial of intensity-modulated proton therapy (IMPT) versus intensity-modulated photon therapy (IMRT) for the treatment of head and neck oropharyngeal carcinoma (OPC).”
Breaking Down the Study
Let’s look at this critical research a little more, which focused on patients with Stage III and Stage IV oropharyngeal cancer:
What is a Phase III trial?
After testing a new treatment among smaller groups of people in Phase I and II trials, a Phase III trial opens this new treatment to hundreds of patients at multiple facilities across the United States. This trial enrolled patients at over 21 radiation centers in the United States.
What is a randomized trial?
A randomized trial helps reduce the possibility of bias and improves the chances of more accurate results. This trial treated half of the 440 patients with traditional radiation (IMRT) and the other half with proton beam therapy (IMPT). Patients also received concurrent chemotherapy as this is standard of care for oropharyngeal cancer.
What was this study measuring?
The researchers measured outcomes at three years following completion of radiation therapy. These outcomes were compared between patients treated with proton beam therapy (IMPT) and those treated with IMRT. The authors were interested in comparing cure rates, overall survival rates, the number of patients requiring feeding tubes during or after treatment and weight loss.
What was the study’s conclusion?
The results showed that proton beam therapy (IMPT) improved outcomes for patients treated for head and neck oropharyngeal cancer. Fewer patients required a feeding tube (28% vs 42%) and more patients minimized their weight loss (24% vs 14%) with proton radiation treatment for head and neck oropharyngeal cancer3. Frank et al. concluded that proton beam therapy (IMPT) “has emerged as a standard of care” for oropharyngeal cancer.
This exciting research shared with the cancer world has the potential to reduce treatment complications for people affected by head and neck oropharyngeal cancers.
More About Head & Neck Cancer Treatment at the UF Health Proton Therapy Institute
The UF Health Proton Therapy Institute takes a multidisciplinary approach to treating oral, head and neck cancers. Adults and children who are being treated at the Institute have access to the multidisciplinary team of specialists and subspecialists at the University of Florida.
At the Institute, tumor boards meet weekly to review cases and plan the best treatment for each individual. The Preston A. Wells Jr. Center for Brain Tumor Therapy in Gainesville, the UF Department of Oral and Maxillofacial Surgery – Jacksonville and the UF Health Skull Base Center at UF Health Jacksonville all participate in the weekly tumor board meetings with the UF Health Proton Therapy Institute. Read more about this treatment planning in our February edition of Precision.
Proton therapy, an advanced form of radiation treatment designed to combat cancer cells by targeting them more precisely, and its application in head and neck cancer is becoming more widely accepted. Unlike conventional photon-based treatments, proton therapy utilizes the ability of protons to stop at a designated depth in the body, minimizing radiation exposure to surrounding healthy tissues and can be used for many types of cancer.
This targeted approach has the potential to reduce toxicity, a significant concern in squamous cell cancer treatment of the head and neck region. Avoiding radiation to the jawbone, salivary glands, eyes and spinal cord are critical in reducing treatment-related side effects, such as dry mouth and swallowing difficulty, as well as improving overall treatment success. Read more about proton beam therapy for squamous cell cancer treatment of the head and neck region in a recent blog post.
Clinical Trial for Head and Neck Cancers
At the UF Health Proton Therapy Institute, physicians also continue to explore how to deliver proton therapy for head and neck cancer patients with fewer side effects. There is an open clinical trial led by Roi Dagan, MD, MS, to learn more. Again, the focus is on patients with HPV.
Prior research shows that most people with HPV (Human papillomavirus) related oropharyngeal squamous cell carcinoma (OPSCC) have a substance called cell-free HPV DNA (cfHPV DNA) in their blood. In addition to the detectability of cfHPV, this study explores the notion that lower doses of radiation therapy may be as effective as the standard higher doses used presently. This could result in fewer side effects with apparent equal effectiveness against these types of head and neck cancers.
HPV is a primary focus in research for advancing head and neck cancer treatments, as there is an unfortunate new trend in which younger people are being diagnosed with oral, head and neck cancers. According to the Oral Cancer Foundation, the fastest-growing segment of oral cancer patients is young, healthy, nonsmoking individuals due to the connection to the HPV virus.
Find out more about why proton therapy makes sense for cancers of the head and neck.
Reviewed September 26, 2024, by Curtis Bryant, MD, MPH
