A MD Anderson study published in the Green Journal reported on the patterns of failure following proton beam therapy (PBT) for pediatric H&N RMS. 46 patients were analyzed. With median follow-up of 3.9 years, five-year overall survival was 76%, and five-year progression-free survival was 57%. Seventeen patients (37%) experienced relapse, including 7 with local failure (LF). Five-year local control (LC) was 84%.

Tumor size greater than 5 cm predicted increased risk of LF, intracranial extension (ICE) and delayed RT delivery after week 4 of chemotherapy predicted increased risk of relapse. This study concluded that PBT confers excellent LC, and a favorable late toxicity profile as compared with prior photon RT data. This study also raised concerns regarding excess failures among patients with ICE.