Top Line: Does proton therapy reduce acute mucositis in patients receiving adjuvant radiation for resected head and neck cancer?
The Study: Recently, two randomized trials have compared proton and photon therapy in the definitive treatment of HNSCC. One showed less toxicity with proton therapy while the other showed no major benefits with proton therapy. In this phase 2 trial, 98 patients with resected, well lateralized HNSCC that were planned to receive adjuvant RT to the unilateral primary site and neck were randomized to photon or proton therapy. Everyone received 60 Gy in 30 fractions to involved sites with 54 Gy to elective regions. Overall, outcomes were excellent across the board with no differences in local control, PFS, or OS at 3 years. The primary outcome of clinician-graded acute grade 2+ mucositis was significantly lower with proton therapy (7.4% v 22.7%). Grade 2+ dysgeusia was also lower with proton therapy (9.3% v 31.8%). However, there were no significant differences in patient-reported adverse effects. Dermatitis and dysphagia were similar between arms. Late adverse effects were low with no differences between arms.
TBL: In this trial, the use of protons for unilateral adjuvant RT for HNSCC reduced clinician reported grade 2+ mucositis and dysgeusia, but treatment outcomes, patient reported outcomes, and late effects were similar. | Dee, J Natl Cancer Inst 2026
The Study: Recently, two randomized trials have compared proton and photon therapy in the definitive treatment of HNSCC. One showed less toxicity with proton therapy while the other showed no major benefits with proton therapy. In this phase 2 trial, 98 patients with resected, well lateralized HNSCC that were planned to receive adjuvant RT to the unilateral primary site and neck were randomized to photon or proton therapy. Everyone received 60 Gy in 30 fractions to involved sites with 54 Gy to elective regions. Overall, outcomes were excellent across the board with no differences in local control, PFS, or OS at 3 years. The primary outcome of clinician-graded acute grade 2+ mucositis was significantly lower with proton therapy (7.4% v 22.7%). Grade 2+ dysgeusia was also lower with proton therapy (9.3% v 31.8%). However, there were no significant differences in patient-reported adverse effects. Dermatitis and dysphagia were similar between arms. Late adverse effects were low with no differences between arms.
TBL: In this trial, the use of protons for unilateral adjuvant RT for HNSCC reduced clinician reported grade 2+ mucositis and dysgeusia, but treatment outcomes, patient reported outcomes, and late effects were similar. | Dee, J Natl Cancer Inst 2026