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IMRT and Proton Therapy Show Similar Outcomes in Oropharyngeal Cancer Trial
A new phase III clinical trial has found that intensity-modulated radiation therapy (IMRT) and proton-beam therapy resulted in similar quality-of-life outcomes and low rates of side effects for people wiht locally advanced oropharyngeal cancer. The TORPEdO trial, a randomized study conducted across the United Kingdom, found no meaningful differences between the treatments in patient-reported quality of life, swallowing function, or feeding tube dependence at 1 year. both advanced radiation approaches resulted in excellent tumor control and notably fewer long-term side effects than expected. Initial results of the trial were presented at the American Society for Radiation Oncology (ASTRO) 2025 Annual Meeting (Abstract LBA 02).
“We found no evidence of a difference in late patient-reported physical side effects or quality of life between proton-beam therapy and IMRT, with contemporary IMRT performing better than we anticipated,” said David Thomson, MD, Chief Investigator of the trial and a consultant clinical oncologist at The Christie NHS Foundation Trust in Manchester, England. “Our results confirm that high-quality IMRT is a very good treatment for this disease.”
Study Background
The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is rising in many countries due to increasing human papillomavirus (HPV) infection, a primary driver of the disease. It is the most common HPV-related cancer in men and the second most common in women. Standard treatment for locally advanced OPSCC involves IMRT combined with chemotherapy, and while this treatment is highly effective at curing and controlling cancer, it can also cause severe side effects such as difficulty with swallowing that may require the use of a feeding tube.
IMRT is an advanced photon-based technique that shapes and modulates radiation beams to precisely target tumors. Photon beams effectively eliminate cancer tumors but scatter bits of radiation along the way that can lead to side effects in the treated area. Proton therapy, a newer approach, uses proton beams that deposit less radiation along their path to the tumor, potentially sparing surrounding healthy tissue and resulting in fewer side effects. This type of radiation treatment requires specialized facilities and training, though, and is thus less widely available and substantially more expensive.
“There’s been interest in the use of proton-beam therapy specifically for head and neck cancers because of the intricate nature of treating this area, with nearby organs for chewing, swallowing, speech, hearing, and other important functions.Trying to reduce the radiation dose to these organs is important because it may result in fewer side effects and improved functioning,” Dr. Thomson said.
TORPEdO Design and Results
In the TORPEdO trial, 205 patients with locally advanced OPSCC were randomly assigned 2:1 to receive either intensity-modulated proton therapy (n = 136) or IMRT (n = 69) with concurrent cisplatin chemotherapy at centers
