Patient-Reported Outcomes after Intensity-Modulated Proton Therapy for Oropharynx Cancer.

To report patient-reported outcomes (PROs) derived from the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) tool, in patients with oropharynx cancer (OPC) treated with intensity-modulated proton therapy (IMPT) in the context of first-course irradiation. Patients with locally advanced OPC treated with radical IMPT between 2011 and 2018 were included in a prospective registry. FACT-HN scores were measured serially during and 24 months following IMPT. PRO changes in the FACT-HN scores over time were assessed with mixed-model analysis. Fifty-seven patients met inclusion criteria. Median age was 60 years (range, 41-84), and 91% had human papillomavirus-associated disease. In total, 28% received induction chemotherapy and 68% had concurrent chemotherapy. Compliance to FACT-HN questionnaire completion was 59%, 48%, and 42% at 6, 12, and 24 months after treatment, respectively. The mean FACT-General (G), FACT-Total, and FACT-Trial Outcome Index (TOI) score changes were statistically and clinically significant relative to baseline from week 3 of treatment up to week 2 after treatment. Nadir was reached at week 6 of treatment for all scores, with maximum scores dropping by 15%, 20%, and 39% compared to baseline for FACT-G, FACT-Total, and FACT-TOI, respectively. Subdomain scores of physical well-being, functional well-being, and head and neck additional concerns decreased from baseline during treatment and returned to baseline at week 4 after treatment. IMPT was associated with a favorable PRO trajectory, characterized by an acute decline followed by rapid recovery to baseline. This study establishes the expected acute, subacute, and chronic trajectory of PROs for patients undergoing IMPT for OPC.

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Conflicts of Interest: There are no conflicts of interest directly relevant to this article; however, the following authors hold unrelated financial and professional relationships as disclosed: Houda Bahig, MD, PhD, is a consultant for Bristol Myers Squibb and has received honorarium from Siemens Healthineers and a research grant from Varian Medical Systems. Steven J. Frank, MD, is an Associate Editor of The International Journal of Particle Therapy. Dr Frank is a consultant/advisory board member for Varian and founder/director for C4 Imaging. He receives honorariums from Hitachi and Augmenix, and he has grant funding from Elekta and Hitachi. Dr Frank and Gary B. Gunn, MD, hold leadership positions at the Proton Therapy Center at The University of Texas MD Anderson Cancer Center. David I. Rosenthal, MD, has research support and is a paid scientific advisor for Merck.