The quality of radiation therapy has been shown to significantly influence the outcomes for head and neck squamous cell carcinoma (HNSCC) patients. The results of dosimetric studies suggest that intensity-modulated proton therapy (IMPT) could be of added value for HNSCC by being more effective than intensity-modulated (photon) radiation therapy (IMRT) for reducing side effects of radiation therapy. However, the physical properties of protons make IMPT more sensitive than photons to planning uncertainties. This could potentially have a negative effect on the quality of IMPT planning and delivery. For this review, the three French proton therapy centers collaborated to evaluate the differences between IMRT and IMPT. The review explored the effects of these uncertainties and their management for developing a robust and optimized IMPT treatment delivery plan to achieve clinical outcomes that are superior to those for IMRT. We also provide practical suggestions for the management of HNSCC carcinoma with IMPT. Because metallic dental implants can increase range uncertainties (3-10%), patient preparation for IMPT may require more systematic removal of in-field alien material than is done for IMRT. Multi-energy CT may be an alternative to calculate more accurately the dose distribution. The practical aspects that we describe are essential to guarantee optimal quality in radiation therapy in both model-based and randomized clinical trials.

中文翻译：

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头颈部鳞状细胞癌的质子治疗：物理和临床挑战综述

放射治疗的质量已被证明显着影响头颈部鳞状细胞癌 (HNSCC) 患者的预后。剂量学研究的结果表明，调强质子治疗 (IMPT) 在减少放射治疗的副作用方面比调强（光子）放射治疗 (IMRT) 更有效，因此可为 HNSCC 带来附加值。然而，质子的物理特性使 IMPT 比光子对规划不确定性更敏感。这可能会对 IMPT 计划和交付的质量产生负面影响。在本次审查中，三个法国质子治疗中心合作评估了 IMRT 和 IMPT 之间的差异。该评价探讨了这些不确定性的影响及其管理，以制定稳健和优化的 IMPT 治疗实施计划，以实现优于 IMRT 的临床结果。我们还为使用 IMPT 治疗 HNSCC 癌提供了实用建议。由于金属牙种植体会增加范围的不确定性 (3-10%)，因此与 IMRT 相比，IMPT 的患者准备可能需要更系统地去除现场异物。多能量 CT 可能是更准确计算剂量分布的替代方法。我们描述的实际方面对于保证基于模型和随机临床试验中放射治疗的最佳质量至关重要。我们还为使用 IMPT 治疗 HNSCC 癌提供了实用建议。由于金属牙种植体会增加范围的不确定性 (3-10%)，IMPT 的患者准备可能需要比 IMRT 更系统地去除现场异物。多能量 CT 可能是更准确计算剂量分布的替代方法。我们描述的实际方面对于保证基于模型和随机临床试验中放射治疗的最佳质量至关重要。我们还为使用 IMPT 治疗 HNSCC 癌提供了实用建议。由于金属牙种植体会增加范围的不确定性 (3-10%)，IMPT 的患者准备可能需要比 IMRT 更系统地去除现场异物。多能量 CT 可能是更准确计算剂量分布的替代方法。我们描述的实际方面对于保证基于模型和随机临床试验中放射治疗的最佳质量至关重要。