BACKGROUND AND PURPOSE IMPT improves normal tissue sparing compared to VMAT in treating oropharyngeal cancer (OPC). Our aim was to assess if this translates into clinical benefits. MATERIALS AND METHODS OPC patients treated with definitive or adjuvant IMPT or VMAT from 2013 to 2018 were included. All underwent prospective assessment using patient-reported-outcomes (PROs) (EORTC-QLQ-H&N35) and provider-assessed toxicities (CTCAEv4.03). End-of-treatment and pretreatment scores were compared. PEG-tube use, hospitalization, and narcotic use were retrospectively collected. Statistical analysis used the Wilcoxon Rank-Sum Test with propensity matching for PROs/provider-assessed toxicities, and t-tests for other clinical outcomes. RESULTS 46 IMPT and 259 VMAT patients were included; median follow-up was 12 months (IMPT) and 30 months (VMAT). Baseline characteristics were balanced except for age (p = 0.04, IMPT were older) and smoking (p < 0.01, 10.9% IMPT >20PYs, 29.3% VMAT). IMPT was associated with lower PEG placement (OR = 0.27; 95% CI: 0.12-0.59; p = 0.001) and less hospitalization ≤60 days post-RT (OR = 0.21; 95% CI:0.07-0.6, p < 0.001), with subgroup analysis revealing strongest benefits in patients treated definitively or with concomitant chemoradiotherapy (CRT). IMPT was associated with a relative risk reduction of 22.3% for end-of-treatment narcotic use. Patients reported reduced cough and dysgeusia with IMPT (p < 0.05); patients treated definitively or with CRT also reported feeling less ill, reduced feeding tube use, and better swallow. Provider-assessed toxicities demonstrated less pain and mucositis with IMPT, but more mucosal infection. CONCLUSION IMPT is associated with improved PROs, reduced PEG-tube placement, hospitalization, and narcotic requirements. Mucositis, dysphagia, and pain were decreased with IMPT. Benefits were predominantly seen in patients treated definitively or with CRT.

中文翻译：

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调强质子疗法 (IMPT) 和容积调制弧疗法 (VMAT) 治疗口咽癌的急性毒性和患者报告结果的比较分析

背景和目的 与 VMAT 相比，IMPT 在治疗口咽癌 (OPC) 方面改善了正常组织的保留。我们的目标是评估这是否转化为临床益处。材料与方法 纳入 2013 年至 2018 年接受根治性或辅助性 IMPT 或 VMAT 治疗的 OPC 患者。所有患者都接受了使用患者报告结果 (PRO) (EORTC-QLQ-H&N35) 和提供者评估的毒性 (CTCAEv4.03) 的前瞻性评估。比较治疗结束和治疗前的评分。回顾性收集了 PEG 管的使用、住院和麻醉剂使用情况。统计分析使用 Wilcoxon Rank-Sum 检验与 PROs/提供者评估毒性的倾向匹配，以及其他临床结果的 t 检验。结果 包括 46 名 IMPT 和 259 名 VMAT 患者；中位随访时间为 12 个月（IMPT）和 30 个月（VMAT）。除了年龄（p = 0.04，IMPT 年龄较大）和吸烟（p < 0.01，10.9% IMPT >20PYs，29.3% VMAT）之外，基线特征是平衡的。IMPT 与较低的 PEG 放置相关（OR = 0.27；95% CI：0.12-0.59；p = 0.001）和更少的住院治疗（OR = 0.21；95% CI：0.07-0.6，p < 0.001） ，亚组分析显示最终治疗或伴随放化疗 (CRT) 的患者获益最大。IMPT 与治疗结束麻醉品使用的相对风险降低 22.3% 相关。患者报告使用 IMPT 后咳嗽和味觉障碍减轻（p < 0.05）；接受彻底治疗或接受 CRT 治疗的患者也报告说感觉不适，减少了饲管的使用，吞咽更好。提供者评估的毒性表明 IMPT 的疼痛和粘膜炎较少，但粘膜感染较多。结论 IMPT 与改善 PRO、减少 PEG 管放置、住院和麻醉需求相关。IMPT 可减轻粘膜炎、吞咽困难和疼痛。获益主要见于明确治疗或接受 CRT 的患者。