ESMO open · 2026
Comparison of intensity-modulated proton therapy (IMPT) and intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer: efficacy and toxicity differ by outcome measure.
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You J, You J, Xu B, Zhou Z
Аннотация
AIM: Whether intensity-modulated proton therapy (IMPT) offers measurable clinical benefits over intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer remains debated.
METHODS: We pooled data from two phase III randomized trials and one matched cohort study comparing IMPT with IMRT and analyzed disease-control, survival, acute toxicity, and nutritional outcomes.
RESULTS: The hazard ratio for locoregional recurrence was 1.37 [95% confidence interval (CI) 0.56-3.36, I2 = 0%]; for progression-free survival, 0.90 (95% CI 0.61-1.33, I2 = 0%); and for overall survival, 0.79 (95% CI 0.32-1.98, I2 = 47%). Acute grade 3 dysphagia occurred in 24% of patients receiving IMPT, compared with 40.9% receiving IMRT [risk ratio (RR) 0.65, 95% CI 0.51-0.84, I2 = 0%]. Grade 3 xerostomia or oral/pharyngeal dryness occurred in 19.9% and 32.5%, respectively (RR 0.72, 95% CI 0.54-0.95, I2 = 0%). Exploratory nutritional outcomes showed no definitive benefit, including 12-month gastrostomy dependence (RR 0.32, 95% CI 0.08-1.28, I2 = 0%), weight loss ≥20% (RR 1.05, 95% CI 0.12-9.38, I2 = 85.7%), and composite nutritional endpoints (RR 0.92, 95% CI 0.12-7.07, I2 = 87.7%).
CONCLUSIONS: IMPT's primary advantage is reducing acute toxicity, not improving efficacy.
METHODS: We pooled data from two phase III randomized trials and one matched cohort study comparing IMPT with IMRT and analyzed disease-control, survival, acute toxicity, and nutritional outcomes.
RESULTS: The hazard ratio for locoregional recurrence was 1.37 [95% confidence interval (CI) 0.56-3.36, I2 = 0%]; for progression-free survival, 0.90 (95% CI 0.61-1.33, I2 = 0%); and for overall survival, 0.79 (95% CI 0.32-1.98, I2 = 47%). Acute grade 3 dysphagia occurred in 24% of patients receiving IMPT, compared with 40.9% receiving IMRT [risk ratio (RR) 0.65, 95% CI 0.51-0.84, I2 = 0%]. Grade 3 xerostomia or oral/pharyngeal dryness occurred in 19.9% and 32.5%, respectively (RR 0.72, 95% CI 0.54-0.95, I2 = 0%). Exploratory nutritional outcomes showed no definitive benefit, including 12-month gastrostomy dependence (RR 0.32, 95% CI 0.08-1.28, I2 = 0%), weight loss ≥20% (RR 1.05, 95% CI 0.12-9.38, I2 = 85.7%), and composite nutritional endpoints (RR 0.92, 95% CI 0.12-7.07, I2 = 87.7%).
CONCLUSIONS: IMPT's primary advantage is reducing acute toxicity, not improving efficacy.