Insights from initial experience for nasopharyngeal carcinoma patients treated with proton therapy

Radiotherapy is the cornerstone for the treatment of nasopharyngeal carcinoma (NPC). Due to its unique epidemiology and the location of the disease with neighbouring critical structures, conventional photon irradiation may result in significant long-term morbidities in patients. With increasing numbers of proton beam therapy (PBT) centres worldwide, patients with NPC now have an alternative option of irradiation that potentially gives equivalent disease control, yet significantly reduces the acute and long-term toxicities. The proper adoption of PBT in NPC requires a series of intricate procedures: pre-treatment preparation, treatment planning, advanced image verification and adaptive PBT. Each process is crucial to allow the proton beam deposit precise dose in Bragg peak's region, resulting in optimal planned target volume coverage while allowing maximum sparing of adjacent dose-limiting organs. Therefore, comprehensive protocols for these coordinated procedures have been developed at our centre to achieve optimal outcomes for patients with NPC.