Revisiting proton therapy for adenoid cystic carcinoma: a case worth making
12 affiliations
- 1Drexel University College of Medicine, Philadelphia, PA, United States
- 2Mayo Clinic in Florida Department of Radiation Oncology, Jacksonville, FL, United States
- 3University of North Carolina Department of Radiation Oncology, Chapel Hill, NC, United States
- 4Mayo Clinic Minnesota Department of Radiation Oncology, Rochester, MN, United States
- 5University of Florida Proton Therapy Institute, Jacksonville, FL, United States
- 6Radiation Oncology Unit, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
- 7Hong Kong Sanitorium Hospital, Comprehensive Oncology Centre, Hong Kong, Hong Kong SAR, China
- 8Corewell Health, Royal Oak, MI, United States
- 9Mayo Clinic Arizona, Scottsdale, AZ, United States
- 10Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- 11Gunma University Heavy Ion Medical Center, Gunma, Japan
- 12Memorial Sloan Kettering Cancer Center, New York, NY, United States
Abstract
Background: Adenoid cystic carcinoma (ACC) is a rare malignancy characterized by indolent growth, frequent perineural invasion, and a propensity for locally advanced disease involving the skull base. High-dose radiation to complex target volumes must be balanced with minimizing exposure to adjacent organs at risk, making particle therapy attractive. Proton beam therapy (PBT) and carbon ion radiotherapy (CIRT) provide favorable dose distributions compared with photon-based radiotherapy, while CIRT offers additional theoretical radiobiologic advantages through its higher linear energy transfer and relative biological effectiveness. However, whether these properties translate into superior clinical outcomes remains uncertain.
Methods: This perspective reviews physical and radiobiologic characteristics of PBT and CIRT and evaluates contemporary clinical evidence supporting their use in ACC. Available studies demonstrate favorable local control, overall survival, and toxicity outcomes with both modalities but have not established a clear clinical advantage of CIRT over modern PBT. Interpretation is limited by heterogeneous patient populations, treatment techniques, fractionation schedules, institutional practices, follow-up, and the absence of prospective data. Additionally, differences in infrastructure, cost, geographic availability, and reimbursement influence treatment selection and patient access.
Results: Current evidence supports PBT as an efficacious and broadly applicable treatment option for ACC, particularly for complex skull base and perineural target volumes. Future research should prioritize comparative dosimetry, refinement of biologic dose modeling, multicenter clinical outcomes, contemporary cost-effectiveness analyses, and patient selection. Expanding equitable access to particle therapy should remain a parallel objective.
Conclusion: Current literature supports PBT in the treatment of ACC. Reported treatment outcomes are comparable to CIRT.
Related
- Proton beam therapy in the treatment of adenoid cystic carcinoma of the head and neck: a single enterprise retrospective cohort study
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- Challenges in managing tracheal adenoid cystic carcinoma of the proximal trachea complicated by COVID-19 and bilateral vocal cord palsy
- Postoperative radiotherapy after tracheal reconstruction with cryopreserved aortic allograft for adenoid cystic carcinoma
- Coordinated alterations in SWI/SNF chromatin remodeling complex, mRNA splicing and mRNA methylation as hallmarks of salivary gland adenoid cystic carcinoma (SACC)
BibTeX
@article{rohit2026revisiting,
title = {{Revisiting proton therapy for adenoid cystic carcinoma: a case worth making}},
author = {Astha Rohit and Adam Holtzman and James Bates and Scott Lester and Roi Dagan and Barbara Vischioni and Ester Orlandi and Maria Bonora and Amy Tien Yee Chang and Rohan Deraniyagala and Martin Bues and Steven Frank and Samir H. Patel and Atsushi Musha and Tatsuya Ohno and Nancy Lee and Lisa McGee},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1979803},
url = {https://doi.org/10.3389/fonc.2026.1979803},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Revisiting proton therapy for adenoid cystic carcinoma: a case worth making
AU - Astha Rohit
AU - Adam Holtzman
AU - James Bates
AU - Scott Lester
AU - Roi Dagan
AU - Barbara Vischioni
AU - Ester Orlandi
AU - Maria Bonora
AU - Amy Tien Yee Chang
AU - Rohan Deraniyagala
AU - Martin Bues
AU - Steven Frank
AU - Samir H. Patel
AU - Atsushi Musha
AU - Tatsuya Ohno
AU - Nancy Lee
AU - Lisa McGee
PY - 2026
DA - 2026/10/12
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1979803
UR - https://doi.org/10.3389/fonc.2026.1979803
AB - Background: Adenoid cystic carcinoma (ACC) is a rare malignancy characterized by indolent growth, frequent perineural invasion, and a propensity for locally advanced disease involving the skull base. High-dose radiation to complex target volumes must be balanced with minimizing exposure to adjacent organs at risk, making particle therapy attractive. Proton beam therapy (PBT) and carbon ion radiotherapy (CIRT) provide favorable dose distributions compared with photon-based radiotherapy, while CIRT offers additional theoretical radiobiologic advantages through its higher linear energy transfer and relative biological effectiveness. However, whether these properties translate into superior clinical outcomes remains uncertain. Methods: This perspective reviews physical and radiobiologic characteristics of PBT and CIRT and evaluates contemporary clinical evidence supporting their use in ACC. Available studies demonstrate favorable local control, overall survival, and toxicity outcomes with both modalities but have not established a clear clinical advantage of CIRT over modern PBT. Interpretation is limited by heterogeneous patient populations, treatment techniques, fractionation schedules, institutional practices, follow-up, and the absence of prospective data. Additionally, differences in infrastructure, cost, geographic availability, and reimbursement influence treatment selection and patient access. Results: Current evidence supports PBT as an efficacious and broadly applicable treatment option for ACC, particularly for complex skull base and perineural target volumes. Future research should prioritize comparative dosimetry, refinement of biologic dose modeling, multicenter clinical outcomes, contemporary cost-effectiveness analyses, and patient selection. Expanding equitable access to particle therapy should remain a parallel objective. Conclusion: Current literature supports PBT in the treatment of ACC. Reported treatment outcomes are comparable to CIRT.
SN - 2234-943X
ER -