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J Neurol Surg B Skull Base
DOI: 10.1055/a-2708-2656
Original Article

Proton Versus Photon Radiation Therapy for Nasopharyngeal Carcinoma

Authors

  • Arash Abiri 

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California

  • Derek H. Liu

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California

  • Jonathan C. Pang 

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California

  • Theodore V. Nguyen

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California

  • Benjamin F. Bitner

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California

  • Sina J. Torabi

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California

  • Edward C. Kuan 

    1   Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, Orange, California
    2   Department of Neurological Surgery, University of California, Irvine, Orange, California
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Abstract

Objectives

Local treatment for nasopharyngeal carcinoma (NPC) commonly entails a regimen of radiotherapy. Due to its proximity to critical neurovascular structures, radiotoxicity presents a challenge. Proton radiotherapy (PRT) is associated with reduced toxicity and shows promise as an alternative to photon radiotherapy (XRT). Herein, we evaluated the therapeutic efficacies of PRT and XRT in NPC patients.

Study Design

Retrospective database study.

Methods

The 2004–2017 National Cancer Database was queried for patients with NPC who were treated with PRT or XRT. Using propensity score matching (PSM), patients who received XRT were matched in demographics and clinical characteristics with those who received PRT. Overall survival (OS) was assessed with Cox proportional-hazards regression and Kaplan-Meier analysis.

Results

Of 7,003 patients (6,953 XRT, 50 PRT), 1,946 (27.8%) were female with a mean age of 55.7 ± 14.0 years. PSM resulted in 96 patients, with a large representation of T4 (57.3%), M0 (91.7%), and WHO type I (54.2%) tumors. Patients who underwent PRT were, on average, farther away from their treatment facility than XRT patients (101.7 versus 14.0 miles; p < 0.001). The 2-year OS rates for the PRT and XRT cohorts were 83.9 and 53.9%, respectively (p = 0.002). Additionally, PRT was associated with significantly reduced mortality compared with XRT (HR 0.338; p = 0.002).

Conclusion

NPC patients demonstrated higher OS following PRT compared with XRT. Prospective trials consisting of larger and more heterogeneous patient populations are warranted to better delineate the therapeutic efficacy of PRT and direct its appropriate use as a primary radiation modality for NPC patients.

Keywords

nasopharyngeal cancer - radiotherapy - proton therapy - photon therapy - survival

Note

Portions of this work were presented as a talk at the 2023 Triological Society at Combined Otolaryngology Spring Meetings, Boston, MA.




Publication History

Received: 14 February 2025

Accepted: 22 September 2025

Accepted Manuscript online:
24 September 2025

Article published online:
07 October 2025

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