This indication includes adjuvant and radical radiotherapy (eventually chemoradiotherapy) at all stages where radiotherapy is indicated (without distant dissemination). This is a generally accepted indication for proton radiotherapy, confirmed by meta-analyzes.
Due to the location of the disease, photons usually do not allow the application of curative doses around 70 Gy, while protecting the eyes, optical pathways and inner ear.
Proton radiotherapy minimizes the dose of radiation to the brain, including hippocampi – radiation in this area is the cause of cognitive dysfunctions.
There is a significant reduction in doses to the esophagus, larynx and constants of the pharynx when irradiation of the cervical nodes is needed. In the vast majority of cases, patients undergoing proton therapy don’t need a PEG tube and the risk of chronic dysphagia is reduced.
Nasopharyngeal tumors require radical chemoradiotherapy at all stages in the absence of distant dissemination.
In both cases, there is a significant reduction in doses to the larynx, pharynx and esophagus. In most cases, treatment does not lead to the need for a PEG tube, therefore reducing the risk of long-term dysphagic problems.
Proton radiotherapy can be adjuvant or radical chemo-radiotherapy at all stages where radiotherapy is indicated (without distant dissemination). In both curative and adjuvant radiotherapy, the range of protons in the tissue is an advantage for this diagnosis.
In salivary gland tumors, radiotherapy is always performed unilaterally and the applied dose is limited exclusively to the required target volume. This allows for a significant dose reduction to contralateral structures, central structures in tumors with a tendency to perineural spread along cranial nerves, brain, brainstem and ipsilateral inner ear.
For tonsil cancer, adjuvant radiotherapy chemo-radiotherapy is used at all stages where radiotherapy is indicated (without distant dissemination). The advantage of reducing the burden of unwanted radiation to healthy tissue in patients with very high curability and long expected survival is combined with a favorable unilateral target volume for radiotherapy (at least in the saturation phase of radiotherapy).
It is both a reduction of the integral dose and a reduction of doses to midline organs, especially the larynx, pharyngeal constrictors and esophagus.
Re-irradiation in the ENT area is a recognized indication for proton radiotherapy. The reason is the high risk of serious damage to surrounding tissues caused by additional photon radiotherapy. In principle, proton re-irradiation is the last possible treatment and its implementation is given more by the location of the recurrence. Recurrences in the area of the nasopharynx, parapharyngeal space, parotid arteries, cranial base seem to be the most suitable. Recurrences in the area of the oral cavity, larynx, hypopharynx seem to be less suitable.
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