Proton therapy for oropharyngeal cancer: survival, toxicity, and functional outcomes
Mené au Royaume-Uni sur 205 patients atteints d’un carcinome épidermoïde de l’oropharynx de stade localement avancé (durée médiane de suivi : 28,3 mois ; 20 % de femmes), cet essai randomisé multicentrique de phase III évalue l'efficacité, du point de vue des fonctions physiques et de la qualité de vie à 12 mois, d'une protonthérapie avec modulation d'intensité par rapport à une radiothérapie à intensité modulée
Definitive chemoradiotherapy remains the cornerstone of treatment for locally advanced oropharyngeal squamous-cell carcinoma. The transition from 3D conformal radiotherapy to intensity-modulated radiotherapy (IMRT) fundamentally transformed toxicity outcomes, reducing xerostomia and long-term swallowing dysfunction in landmark head and neck trials. These issues have become increasingly relevant as the epidemiology of oropharyngeal squamous-cell carcinoma has shifted towards human papillomavirus-associated disease in younger patients with long life expectancy. In this context, treatment de-escalation and toxicity mitigation have emerged as central priorities. Intensity-modulated proton therapy (IMPT), by reducing integral radiation dose to uninvolved normal tissues, has been proposed as a strategy to further mitigate toxicity while maintaining oncological efficacy. Dosimetric advantages in sparing important swallowing structures and hematopoietic tissues have been suggested. Phase 3 trials, including the UK TORPEdO study, now provide the highest level of prospective evidence to guide clinical decision making.
The Lancet , commentaire en libre accès, 2026