Proton therapy is an attractive tool for certain head and neck cancers to limit exit dose and thereby potentially slash a number of unwanted treatment toxicities. On the flip side, superficial entrance dose can be much higher with limited beam angles. Besides the oft-cited increased skin toxicity that can come with proton therapy to almost any site, head and neck proton therapy poses the unique challenge of undesired mandible dose. This retrospective look at 122 patients receiving head and neck proton therapy at MSK from 2013-2019 reports a hefty rate of jaw osteoradionecrosis of nearly 11%, most commonly at the posterior ipsilateral mandible receiving prescription dose. This is double the rate typically seen with modern IMRT and more in line with 3D techniques of yore.
- Singh, JAMA Otolaryngol Head Neck Surg