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Nasopharyngeal cancer is one of common head and neck cancer in Chinese people. The nasopharynx is located under the skull base and nearly to a lot of critical organs such as brain stem, spinal cord, pituitary fossa and etc. It is very difficult to approach by surgical intervention without sacrifice the cosmetic and functional outcomes. Epidemic nasopharyngeal cancer usually had undifferentiated differentiation with characteristic of very good response to radiotherapy.

Radiotherapy is the major treatment and surgery is reserved as salvage for selected recurrent cases. After a lot of clinical trials, radiotherapy combines with chemotherapy improve the tumor control but also overall survival that become the treatment of choice for stage II-IVa nasopharyngeal carcinoma

Conventional radiotherapy can get good tumor control but at the price of severe radiotherapy induced complications such as dry mouth, swallowing difficulty, hearing impairment, neck fibrosis and cranial palsy, some even will cause mortality. These complications also affect the patients’ long term health related quality of life. With the advancement of radiotherapy technique such as intensity modulation radiotherapy and conformal radiotherapy can reduce the radiation complications but patients will still suffer acute complications such as moderate to severe pain due to radiation induced mucositis and pharyngitis that needs feeding tube to help patients pass the hard time. Taste loss and dry mouth are also let patients loss their ability to enjoy the food. It needs weeks to months to recover from damage. The dry mouth can bother patients for years. Radiotherapy for the nasopharyngeal cancer is always a challenge task for radiation oncologist and a lot of space for improvement.

With the characteristics of proton with rapid radiation dose falling-off and technique advancement of radiation dose calculation and delivery system, intensity modulation proton therapy can provide better radiation dose distribution in tumor and spare more normal tissues compared to intensity modulation radiotherapy. Intensity modulation proton therapy can provide less acute and late complication with similar tumor control probability. The patients will have chance for less pain and dry mouth. It may let patients have better quality of life during and after the radical radiotherapy. Intensity modulation proton therapy can be a new treatment radiotherapy modality to let the patient have a choice.

Article author: Dr. Tung-Chieh Chang