Faculty Collaboration Database

Proton Beam vs Intensity-Modulated Radiotherapy in Olfactory Neuroblastoma. JAMA Otolaryngol Head Neck Surg 2026 Jan 01;152(1):60-64

Date

10/30/2025

Pubmed ID

41165699

Pubmed Central ID

PMC12576614

DOI

10.1001/jamaoto.2025.3816

Scopus ID

2-s2.0-105021587542 (requires institutional sign-in at Scopus site)

Abstract

IMPORTANCE: Adjuvant radiotherapy can improve locoregional control and survival in patients with olfactory neuroblastoma (ONB), particularly with advanced-stage and histologic-grade disease. Standard radiotherapy treatment is with intensity-modulated radiotherapy (IMRT). Proton beam radiotherapy (PBRT) provides theoretical advantages in greater sparing of dose to uninvolved organs at risk.

OBJECTIVE: To investigate if there are differences in the effectiveness and radiation treatment-related adverse events (RTAEs) between adjuvant IMRT and PBRT for patients with ONB.

DESIGN, SETTING, AND PARTICIPANTS: This propensity score-matched cohort study included patients with ONB treated between February 2005 and April 2021 with either IMRT or PBRT at 9 academic tertiary care centers in North America. Patients were matched 1:2 based on age, modified Kadish stage, and Hyams grade. Data were analyzed from July 2024 to January 2025.

EXPOSURE: Adjuvant IMRT or adjuvant PBRT.

MAIN OUTCOMES AND MEASURES: Local recurrence-free survival (RFS), any RFS, and overall survival (OS). RTAEs, ie, grade 2 events or higher based on Common Terminology Criteria for Adverse Events, were recorded for both modalities.

RESULTS: Of 54 included patients, 27 (50%) were female, and the mean (SD) age was 46.2 (15.4) years. A total of 18 were treated with PBRT and 36 were treated with IMRT. Most patients had modified Kadish stage C disease (33 of 54 [61%]), and 24 patients (44%) had Hyams grade III or IV disease. The RTAE rate was 20% (8 of 40); IMRT had a rate of 21% (6 of 29), and PBRT had a rate of 18% (2 of 11). The difference in the point estimates for 10-year RFS showed a potential clinical benefit favoring IMRT, although the wide confidence interval indicates uncertainty (10-year RFS: IMRT, 63.3%; 95% CI, 44.6-89.8; PBRT, 37.8%; 95% CI, 14.2-100; difference, 25.5 percentage points; 95% CI, -17.6 to 68.6). There were no clinically meaningful differences in 10-year local RFS (IMRT, 75.6%; 95% CI, 59.8-95.4; PBRT, 72.7%; 95% CI, 45.2-100; difference, 2.9 percentage points; 95% CI, -35.9 to 41.7) or 10-year OS (IMRT, 61.8%; 95% CI, 42.8-89.1; PBRT, 57.1%; 95% CI, 24.3-100; difference, 4.7 percentage points; 95% CI, -49.2 to 58.6), although wide confidence intervals indicate considerable uncertainty.

CONCLUSIONS AND RELEVANCE: Due to the imprecision of estimates, no definitive conclusions can be made regarding the comparative effectiveness of IMRT vs PBRT for patients with ONB. These preliminary data may inform the design of appropriately powered prospective studies evaluating the efficacy of PBRT vs IMRT in this population.

Author List

Tang A, Adida S, Donohue J, Olson B, Krippaehne E, Roozdar P, Goetschel K, Gago G, Almeida JP, Champagne PO, Fernandez-Miranda JC, Gardner P, Hwang PH, Nayak JV, Patel C, Patel ZM, Celda MP, Pinheiro-Neto C, Routman DM, Sanusi O, Snyderman CH, Thorp BD, Van Gompel JJ, Zenonos GA, Zwagerman NT, Wilke C, Wang EW, Geltzeiler M, Choby G

Author

Nathan Zwagerman MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Esthesioneuroblastoma, Olfactory
Female
Humans
Male
Middle Aged
Nasal Cavity
Nose Neoplasms
Propensity Score
Proton Therapy
Radiotherapy, Adjuvant
Radiotherapy, Intensity-Modulated
Retrospective Studies
Survival Rate