Photon vs. proton radiation therapy in head and neck cancer: a review of dosimetric advantages and patient quality of life

Abstract

Radiotherapy (RT) is a cornerstone in the management of head and neck cancer (HNC), with the choice of RT type profoundly affecting patient outcomes, symptom severity, and quality of life (QoL). This review examines photon and proton RT types for HNC, focusing on dosimetric advantages, efficacy, and side effect profiles. Understanding these factors is crucial to minimizing adverse effects, enhancing QoL for patients, and effectively improving oncology’s clinical praxis. While photon-based therapies, such as intensity-modulated radiation therapy and volumetric modulated arc therapy, are widely used and effective, proton therapy, including intensity-modulated proton therapy (IMPT) and pencil beam scanning (PBS), offers distinct physical advantages. Photon therapies allow for precise dose distribution but often result in higher integral doses to surrounding healthy tissues. In contrast, protons enable highly conformal dose distributions with minimal exit dose beyond the target, a property that significantly reduces radiation exposure to organs at risk. Background research and comparative analysis demonstrate that proton therapy techniques, particularly IMPT and PBS, outperform photon-based methods in sparing critical structures and thus reducing acute and late treatment-related morbidities, such as xerostomia and dysphagia. As a consequence, patient-reported outcome measures and the overall QoL results suggest that proton therapies lead to better treatment results with fewer severe side effects and improved symptom management. In conclusion, proton therapy, particularly IMPT, shows promise as a treatment of choice for HNC, minimizing toxicities and enhancing QoL. However, continued research and evidence-based approaches are still essential to properly validate and refine proton therapy applications in HNC treatment paradigms and also effectively translate them into future clinical practice.

Keywords

Radiation therapy (RT) / IMPT / PBS / IMRT / VMAT / head and neck cancer / patient quality of life / symptoms / toxicity / dosimetry

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