Toxicity with proton therapy for oral and/or oropharyngeal cancers

Abstract

This letter critically evaluates a recent scoping review on the toxicity of proton therapy for oral and oropharyngeal cancers, arguing that several clinically important treatment-related complications require greater attention. The authors emphasize that radiation-induced trismus, a common early toxicity that substantially affects quality of life, was overlooked despite evidence of its high prevalence following proton therapy. They also clarify that osteoradionecrosis of the jaw is primarily a late complication rather than an acute toxicity, although it remains a significant clinical concern, particularly in patients with predisposing risk factors. While acknowledging the superior toxicity profile of proton therapy compared with photon-based radiotherapy, the letter highlights the need for further research on severe toxicities and dose constraints to optimize treatment planning and reduce long-term complications.