Comparison of intensity-modulated proton therapy (IMPT) and intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer: efficacy and toxicity differ by outcome measure
Menée à partir des données de 2 essais randomisés de phase II incluant au total 645 patients atteints d'un cancer de l'oropharynx, cette étude évalue l'efficacité, du point de vue du contrôle de la maladie et de la survie, et la toxicité d'une protonthérapie avec modulation d'intensité par rapport à une radiothérapie avec modulation d'intensité
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.
ESMO Open , article en libre accès, 2026