Photon versus Proton Therapy in the Management of Head and Neck Cancer: A Systematic Review

1. Postgraduate Student, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India. 2. Senior Lecturer, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India. 3. Research Scholar, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.

Abstract

Introduction: Head and Neck Cancers (HNC), particularly Head and Neck Squamous Cell Carcinoma (HNSCC), are major causes of cancer morbidity and mortality. Radiation therapy, commonly using photons, can damage surrounding healthy tissues. Proton Therapy (PT), with its ability to target tumours more precisely, may reduce toxicity and improve Quality Of Life (QOL). The present review compares the efficacy, toxicity, and QOL outcomes of proton versus photon therapies in HNSCC treatment.

Aim: To evaluate and compare PT versus photon therapy in terms of therapeutic efficacy, adverse effects, and QOL in the management of HNC.

Materials and Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic searches were performed across PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar, including studies published from February 2016 to January 2024. Eligible studies involved adult patients diagnosed with HNSCC and compared PT with photon therapy. A total of five studies were included, and their quality was assessed using the Newcastle-Ottawa Scale. A narrative synthesis of findings was performed, focusing on QOL and toxicity profiles.

Results: The PT demonstrated a significant dosimetric advantage over photon therapy, particularly in reducing radiation exposure to critical structures such as salivary glands and the spinal cord. Patients receiving PT showed a 40-50% improvement in QOL, with fewer instances of xerostomia, dental problems, and head and neck pain. In comparison, photon therapy resulted in higher rates of acute and chronic toxicity, including greater feeding tube dependence and increased use of opioid medications. PT was also associated with a reduced incidence of weight loss and a decreased need for pain management compared to photon therapy.

Conclusion: The PT offers a significant dosimetric advantage over photon therapy, improving QOL and reducing toxicity in patients with HNC. While PT has shown promising results, further research with longer follow-up is needed to confirm its long-term benefits and refine treatment protocols. PT is a viable alternative to photon therapy and is recommended for patients with HNSCC, especially those requiring precise radiation delivers to critical structures.

Acute disease, Chronic disease, Dose-response relationship, Quality of life, Radiation, Toxicity