Going pro.

This Dutch feasibility study evaluated the logistics of making decisions on when to employ proton versus photon therapy for head and neck cancer. All cases were first planned with VMAT, and only if the normal tissue complication probability (NTCP) exceeded predefined thresholds was a comparator proton plan generated. The proton plan was then selected only if it could achieve a reduction in NTCP that, again, surpassed predefined thresholds. In other words, neither emotions, gestalt, nor finances were part of the equation. Of 224 cases, two-thirds prompted generation of comparator proton plans, and one-third had proton plans selected. The most common NTCP benefit meriting use of protons was dysphagia. On a related note, the cases most likely to merit protons were those with dysphagia at baseline and/or advanced tumors involving the pharynx. TBL: The Dutch provide a no-nonsense model for practical selection of head and neck cases likely to benefit most for proton versus photon therapy. | Tambas, Radiother Oncol 2020