Mitsutoshi Ooishi1, Atsushi Motegi2, Mitsuhiko Kawashima3, Satoko Arahira3, Sadamoto Zenda3, Naoki Nakamura3, Takaki Ariji4, Sunao Tokumaru5, Minoru Sakuraba6, Makoto Tahara7, Ryuichi Hayashi8, Tetsuo Akimoto3. 1. Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Department of Radiology, Saga University Faculty of Medicine, Saga. 2. Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa amotegi@east.ncc.go.jp. 3. Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa. 4. Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa. 5. Department of Radiology, Saga University Faculty of Medicine, Saga. 6. Divisions of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa. 7. Divisions of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa. 8. Divisions of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
Abstract
OBJECTIVE: To evaluate the feasibility of postoperative intensity-modulated radiotherapy for head and neck cancer by investigating the patterns of failure after this therapy. METHODS: A retrospective chart review was performed. RESULTS: Between March 2006 and December 2013, 122 consecutive patients with head and neck squamous cell carcinoma were treated by surgery followed by postoperative intensity-modulated radiotherapy. In regard to the site of the primary tumor, 59 (48%) patients had cancer of the oral cavity, 31 (26%) patients had cancer of the hypopharynx, 14 (11%) patients had cancer of the oropharynx, 10 (8%) patients had cancer of the larynx and 8 (7%) patients had cancer of unknown primary. The median follow-up period of the surviving patients was 54 months (range, 25-115). Concurrent chemotherapy was administered in 76 patients (62%). The median prescribed radiation dose was 66 Gy. The 3-year overall survival, progression-free survival, distant metastasis free survival and loco-regional control rates were 59%, 48%, 52.4% and 71%, respectively. Of the 122 patients, 32 developed loco-regional recurrence as the initial recurrence, including in-field recurrence in 26 patients, marginal recurrence in five patients and out-field recurrence in seven patients. Of the five patients with marginal recurrence, four have had two or more surgeries before the intensity-modulated radiotherapy and three had oral cavity cancer. Severe adverse events were not frequent, occurring at a frequency of <5%, except for mucositis. No severe toxicities associated with the flap reconstruction were observed either. CONCLUSION: Postoperative intensity-modulated radiotherapy appears to be effective and feasible for patients with head and neck squamous cell carcinoma.
OBJECTIVE: To evaluate the feasibility of postoperative intensity-modulated radiotherapy for head and neck cancer by investigating the patterns of failure after this therapy. METHODS: A retrospective chart review was performed. RESULTS: Between March 2006 and December 2013, 122 consecutive patients with head and neck squamous cell carcinoma were treated by surgery followed by postoperative intensity-modulated radiotherapy. In regard to the site of the primary tumor, 59 (48%) patients had cancer of the oral cavity, 31 (26%) patients had cancer of the hypopharynx, 14 (11%) patients had cancer of the oropharynx, 10 (8%) patients had cancer of the larynx and 8 (7%) patients had cancer of unknown primary. The median follow-up period of the surviving patients was 54 months (range, 25-115). Concurrent chemotherapy was administered in 76 patients (62%). The median prescribed radiation dose was 66 Gy. The 3-year overall survival, progression-free survival, distant metastasis free survival and loco-regional control rates were 59%, 48%, 52.4% and 71%, respectively. Of the 122 patients, 32 developed loco-regional recurrence as the initial recurrence, including in-field recurrence in 26 patients, marginal recurrence in five patients and out-field recurrence in seven patients. Of the five patients with marginal recurrence, four have had two or more surgeries before the intensity-modulated radiotherapy and three had oral cavity cancer. Severe adverse events were not frequent, occurring at a frequency of <5%, except for mucositis. No severe toxicities associated with the flap reconstruction were observed either. CONCLUSION: Postoperative intensity-modulated radiotherapy appears to be effective and feasible for patients with head and neck squamous cell carcinoma.
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