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Peer-reviewedCC BY-NC-ND 4.0ESMO Open

Comparison of intensity-modulated proton therapy (IMPT) and intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer: efficacy and toxicity differ by outcome measure

  • J. You1
  • J. You2
  • B. Xu1,3,4
  • Z. Zhou1,3,4
4 affiliations
  1. 1Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
  2. 2Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
  3. 3Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Fujian Medical University, Fuzhou, China
  4. 4Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
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Abstract

Aim: Whether intensity-modulated proton therapy (IMPT) offers measurable clinical benefits over intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer remains debated.

Methods: We pooled data from two phase III randomized trials and one matched cohort study comparing IMPT with IMRT and analyzed disease-control, survival, acute toxicity, and nutritional outcomes.

Results: The hazard ratio for locoregional recurrence was 1.37 [95% confidence interval (CI) 0.56-3.36, I2 = 0%]; for progression-free survival, 0.90 (95% CI 0.61-1.33, I2 = 0%); and for overall survival, 0.79 (95% CI 0.32-1.98, I2 = 47%). Acute grade 3 dysphagia occurred in 24% of patients receiving IMPT, compared with 40.9% receiving IMRT [risk ratio (RR) 0.65, 95% CI 0.51-0.84, I2 = 0%]. Grade 3 xerostomia or oral/pharyngeal dryness occurred in 19.9% and 32.5%, respectively (RR 0.72, 95% CI 0.54-0.95, I2 = 0%). Exploratory nutritional outcomes showed no definitive benefit, including 12-month gastrostomy dependence (RR 0.32, 95% CI 0.08-1.28, I2 = 0%), weight loss ≥20% (RR 1.05, 95% CI 0.12-9.38, I2 = 85.7%), and composite nutritional endpoints (RR 0.92, 95% CI 0.12-7.07, I2 = 87.7%).

Conclusions: IMPT’s primary advantage is reducing acute toxicity, not improving efficacy.

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Cite

BibTeXRIS
BibTeX
@article{you2026comparison,
  title = {{Comparison of intensity-modulated proton therapy (IMPT) and intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer: efficacy and toxicity differ by outcome measure}},
  author = {J. You and J. You and B. Xu and Z. Zhou},
  journal = {ESMO Open},
  year = {2026},
  month = oct,
  doi = {10.1016/j.esmoop.2026.108602},
  url = {https://doi.org/10.1016/j.esmoop.2026.108602},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Comparison of intensity-modulated proton therapy (IMPT) and intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer: efficacy and toxicity differ by outcome measure
AU  - J. You
AU  - J. You
AU  - B. Xu
AU  - Z. Zhou
PY  - 2026
DA  - 2026/10/20
JO  - ESMO Open
DO  - 10.1016/j.esmoop.2026.108602
UR  - https://doi.org/10.1016/j.esmoop.2026.108602
AB  - Aim: Whether intensity-modulated proton therapy (IMPT) offers measurable clinical benefits over intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer remains debated.  Methods: We pooled data from two phase III randomized trials and one matched cohort study comparing IMPT with IMRT and analyzed disease-control, survival, acute toxicity, and nutritional outcomes.  Results: The hazard ratio for locoregional recurrence was 1.37 [95% confidence interval (CI) 0.56-3.36, I2 = 0%]; for progression-free survival, 0.90 (95% CI 0.61-1.33, I2 = 0%); and for overall survival, 0.79 (95% CI 0.32-1.98, I2 = 47%). Acute grade 3 dysphagia occurred in 24% of patients receiving IMPT, compared with 40.9% receiving IMRT [risk ratio (RR) 0.65, 95% CI 0.51-0.84, I2 = 0%]. Grade 3 xerostomia or oral/pharyngeal dryness occurred in 19.9% and 32.5%, respectively (RR 0.72, 95% CI 0.54-0.95, I2 = 0%). Exploratory nutritional outcomes showed no definitive benefit, including 12-month gastrostomy dependence (RR 0.32, 95% CI 0.08-1.28, I2 = 0%), weight loss ≥20% (RR 1.05, 95% CI 0.12-9.38, I2 = 85.7%), and composite nutritional endpoints (RR 0.92, 95% CI 0.12-7.07, I2 = 87.7%).  Conclusions: IMPT’s primary advantage is reducing acute toxicity, not improving efficacy.
SN  - 2059-7029
ER  -