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This study aimed to evaluate the feasibility of combining helical tomotherapy ( HT ) and intensity‐modulated proton therapy ( IMPT ) in treating patients with nasopharynx cancer ( NPC ). From January 2016 to March 2018, 98 patients received definitive radiation therapy ( RT ) with concurrent chemotherapy ( CCRT ). Using simultaneous integrated boost and adaptive re‐plan, 3 different dose levels were prescribed: 68.4 Gy in 30 parts to  gross tumor volume (GTV) , 60 Gy in 30 parts to high‐risk  clinical target volume (CTV) , and 36 Gy in 18 parts to low‐risk  CTV . In all patients, the initial 18 fractions were delivered by  HT , and, after rival plan evaluation on the adaptive re‐plan, the later 12 fractions were delivered either by  HT  in 63 patients (64.3%,  HT  only) or  IMPT  in 35 patients (35.7%,  HT / IMPT  combination), respectively. Propensity‐score matching was conducted to control differences in patient characteristics. In all patients, grade ≥ 2 mucositis (69.8% vs 45.7%,  P  = .019) and grade ≥ 2 analgesic usage (54% vs 37.1%,  P  = .110) were found to be less frequent in  HT / IMPT  group. In matched patients, grade ≥ 2 mucositis were still less frequent numerically in  HT / IMPT  group (62.9% vs 45.7%,  P  = .150). In univariate analysis, stage  IV  disease and larger  GTV  volume were associated with increased grade ≥ 2 mucositis. There was no significant factor in multivariate analysis. With the median 14 month follow‐up, locoregional and distant failures occurred in 9 (9.2%) and 12 (12.2%) patients without difference by  RT  modality. In conclusion, comparable early oncologic outcomes with more favorable acute toxicity profiles were achievable by  HT / IMPT  combination in treating  NPC  patients.

Early clinical outcomes of helical tomotherapy/intensity‐modulated proton therapy combination in nasopharynx cancer