Is IMPT a Superior Alternative to IMRT for Locally Advanced OPSCC?

Background: With protons being much more expensive than photons, centers have struggled to justify the clinical advantages of protons. A trial that originally began at MD Anderson did show a reduced rate of feeding tube dependencies at 1 year. That trial was questioned because of the MD Anderson non-standard practice of using neoadjuvant chemotherapy for human papillomavirus-positive oropharyngeal cancers and the randomization procedures. That trial was presented at American Society of Clinical Oncology in 2024 and has yet to be published in full form. Objective: To prospectively investigate clinical outcomes in patients with locally advanced oropharyngeal squamous cell cancers (OPSCCs). Design: Phase 3, randomized multicenter trial. Participants: Eligible patients had locally advanced squamous cell cancer of the oropharynx and required definitive, bilateral chemoradiation. Methods: Patients were randomized 2:1 to intensity-modulated proton therapy (IMPT) or intensity-modulated radia more...