Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers

Q: What is the purpose of this study about temporal lobe necrosis?

To determine how often temporal lobe necrosis occurs soon after radiotherapy and to identify differences by head and neck cancer type and by RT method.

Q: How were TLN events detected and graded in the study?

Patients were followed with contrast-enhanced MRI or CT at regular intervals, and TLN was recorded and graded using CTCAE version 5.0.

Q: Did proton beam therapy and volumetric modulated arc therapy differ in TLN risk?

TLN frequency and cumulative risk were similar between PBT and VMAT across patients with any HNC, NPC, and non-NPC HNC in the Kaplan–Meier analyses.

Sep 28, 2026

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Investigates the frequency of temporal lobe necrosis (TLN) shortly after radiotherapy (RT) and identifies differences across head and neck cancer (HNC) types and RT modalities. Retrospectively reviews 483 HNC patients treated after January 2015, with regular follow-ups using contrast-enhanced MRI or CT to detect metastasis or recurrence. Records TLN graded by CTCAE v5.0, compares cumulative TLN occurrence using Kaplan–Meier and Cox regression, and contrasts proton beam therapy (PBT) versus volumetric modulated arc therapy (VMAT) in multiple HNC subgroups. Finds higher TLN in NPC versus non-NPC and similar TLN risk between PBT and VMAT, especially with NPC.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Introduction

Liu et al. Radiation Oncology (2023) 18:155 [https://doi.org/10.1186/s13014-023-02344-y](https://doi.org/10.1186/s13014-023-02344-y) Radiation Oncology RESEARCH Open Access Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers Chi‑Hung Liu 1,2,3, Chien‑Yu Lin2,4,5,6, Bing‑Shen Huang2,4, Yi‑Chia Wei7,8, Ting‑Yu Chang1,2, Chih‑Hua Yeh2,9, Pi‑Shan Sung10, Jian‑Lin Jiang1, Li‑Ying Lin2, Joseph Tung‑Chieh Chang2,4,5* and Kang‑Hsing Fan2,4,5,11* Abstract Background To investigate the frequency of temporal lobe necrosis (TLN) soon after radiotherapy (RT) and identify differences among patients with various types of head and neck cancer (HNC) and between different RT methods. Methods We retrospectively reviewed 483 patients with HNC who had completed RT in our hospital after January, 2015. These patients were followed‑up at the radio‑oncology department and received contrast‑enhanced magnetic resonance imaging (MRI) or computed tomography (CT) to identify metastases or recurrence of cancer at regular intervals. Meanwhile, the occurrence ofTLN, graded according to the Common Terminology Criteria for Adverse Events V5 . 0, was recorded. We categorized the patients into nasopharyngeal carcinoma (NPC) and non‑NPC groups and compared the cumulative occurrence ofTLN between the groups using Kaplan–Meier and Cox regression analy‑ ses. We further compared the cumulative occurrence ofTLN between proton beam therapy (PBT) and volumetric modulated arc therapy (VMAT) in patients with any HNC, NPC, and non‑NPC HNC. Results Compared with the non‑NPC group, the NPC group had a higher frequency ofTLN (5 . 6% vs. 0.4%, p < 0. 01) and were more commonly associated with TLN in the Kaplan–Meier analysis (p < 0. 01) and the Cox regression model after covariates were adjusted for (adjusted hazard ratio: 13. 35, 95% confidence interval: 1.37–130. 61) during the fol‑ low‑up period. Furthermore, the frequency ofTLN was similar between patients receiving PBT and those receiving VMAT (PBT vs. VMAT: 4 . 7% vs. 6. 3%, p = 0 . 76) . Kaplan–Meier analysis revealed that the accumulated risks ofTLN were similar between PBT and VMAT in patients with any HNC (p = 0 .44), NPC (p = 0 . 84), and non‑NPC HNC (p = 0 . 70) . Conclusion Our study demonstrated that patients with NPC are susceptible toTLN during the early period after RT. In addition, PBT may be associated with an equivalent risk ofTLN when compared with VMAT in patients with NPCor other HNCs. Keywords Temporal lobe necrosis, Head and neck cancer, Nasopharyngeal carcinoma, Radiation therapy, Proton therapy *Correspondence: Joseph Tung‑Chieh Chang [cgmhnog@gmail.com](cgmhnog@gmail.com)[ ](cgmhnog@gmail.com)Kang‑Hsing Fan[khs.fan@gmail.com](khs.fan@gmail.com) Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ()[. The Creative Commons Public Domain Dedication waiver (](http://creativecommons.org/licenses/by/4.0/. The Creative Common

FAQs

What is the purpose of this study about temporal lobe necrosis?

To determine how often temporal lobe necrosis occurs soon after radiotherapy and to identify differences by head and neck cancer type and by RT method.

How were TLN events detected and graded in the study?

Patients were followed with contrast-enhanced MRI or CT at regular intervals, and TLN was recorded and graded using CTCAE version 5.0.

Did proton beam therapy and volumetric modulated arc therapy differ in TLN risk?

TLN frequency and cumulative risk were similar between PBT and VMAT across patients with any HNC, NPC, and non-NPC HNC in the Kaplan–Meier analyses.

Sep 28, 2026

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