Planned dose of intensity modulated proton beam therapy versus volumetric modulated arch therapy to tooth-bearing regions

J M Alberga; J Meijer; G M Raghoebar; J A Langendijk; A Korfage; R J H M Steenbakkers; T W H Meijer; H Reintsema; A Vissink; M J H Witjes

doi:10.1016/j.oraloncology.2023.106392

Planned dose of intensity modulated proton beam therapy versus volumetric modulated arch therapy to tooth-bearing regions

Oral Oncol. 2023 May:140:106392. doi: 10.1016/j.oraloncology.2023.106392. Epub 2023 Apr 19.

Authors

Affiliations

¹ Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: j.m.alberga@umcg.nl.
² Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³ Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

PMID: 37084567
DOI: 10.1016/j.oraloncology.2023.106392

Abstract

Background: Intensity modulated proton beam therapy (IMPT) for head and neck cancer offers dosimetric benefits for the organs at risk when compared to photon-based volumetric modulated arch therapy (VMAT). However, limited data exists about the potential benefits of IMPT for tooth-bearing regions. The aim of this study was to compare the IMPT and VMAT radiation dosimetrics of the tooth-bearing regions in head and neck cancer patients. Also, we aimed to identify prognostic factors for a cumulative radiation dose of ≥40 Gy on the tooth-bearing areas, which is considered the threshold dose for prophylactic dental extractions.

Methods: A total of 121 head and neck cancer patients were included in this retrospective analysis of prospectively collected data. We compared the average Dmean values of IMPT versus VMAT of multiple tooth-bearing regions in the same patients. Multivariate logistic regression analysis was performed for receiving a cumulative radiation dose of ≥40 Gy to the tooth-bearing regions (primary endpoint) in both VMAT and IMPT.

Results: A lower Dmean was seen after applying IMPT to the tooth-bearing tumour regions (p < 0.001). Regarding VMAT, oral cavity tumours, T3-T4 tumours, molar regions in the mandible, and regions ipsilateral to the tumour were risk factors for receiving a cumulative radiation dose of ≥40 Gy.

Conclusions: IMPT significantly reduces the radiation dose to the tooth-bearing regions.

Keywords: Dental screening; Head and neck cancer; Intensity modulated proton beam therapy (IMPT); Radiation treatment; Volumetric modulated arch therapy (VMAT).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Head and Neck Neoplasms* / radiotherapy
Humans
Proton Therapy* / adverse effects
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated* / adverse effects
Retrospective Studies