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Initial Experience with Proton Beam Therapy for Differentiated Thyroid Cancer.

Nathan Y Yu1, Aditya Khurana2, Daniel J Ma3

  • 1Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA.

International Journal of Particle Therapy
|July 21, 2021
PubMed
Summary

Intensity-modulated proton therapy (IMPT) shows promise for treating recurrent, radioactive iodine-refractory differentiated thyroid cancer (DTC). Early results indicate good local-regional control with manageable toxicities in this challenging patient group.

Keywords:
intensity-modulated proton therapyproton beam therapythyroid cancer

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Differentiated thyroid cancer (DTC) recurrence, especially when refractory to radioactive iodine (RAI), presents a significant clinical challenge with limited treatment options.
  • External beam radiotherapy is a treatment modality for high-risk DTC, but its role in recurrent, RAI-refractory cases requires further investigation.
  • Intensity-modulated proton therapy (IMPT) offers potential advantages in precise dose delivery, sparing organs at risk.

Purpose of the Study:

  • To evaluate the initial clinical experience and outcomes of intensity-modulated proton therapy (IMPT) in patients with recurrent, radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC).
  • To assess the local-regional control, survival rates, and treatment-related toxicities associated with IMPT in this specific patient population.

Main Methods:

  • A cohort of fourteen patients with recurrent, RAI-refractory DTC were treated with IMPT between November 2016 and March 2020.
  • Patient and tumor characteristics were recorded, and outcomes including overall survival and local-regional recurrence-free survival were estimated using Kaplan-Meier analysis.
  • Acute and late toxicities were graded using Common Terminology Criteria for Adverse Events (CTCAE) v5.0, and patient-reported quality of life was assessed using the EORTC QLQ-HN35 module.

Main Results:

  • With a median follow-up of 8 months, all eleven patients analyzed were alive and showed no local-regional failure.
  • The majority of patients were male, with a median age of 64 years. Common recurrent histologies included papillary and Hurthle cell carcinoma.
  • Acute grade 3 toxicity (dysphagia) occurred in one patient, and two patients experienced late grade 3 esophageal stenosis requiring dilation. No grade 4 or 5 toxicities were observed.

Conclusions:

  • Intensity-modulated proton therapy (IMPT) demonstrates promising local-regional control for patients with recurrent, radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) in this early experience.
  • IMPT appears to be a safe treatment option with a manageable toxicity profile in this challenging patient group.
  • Further research is necessary to confirm the long-term efficacy and safety of IMPT for recurrent, RAI-refractory DTC.