PurposeTo assess changes in oral cavity (OC) shapes and radiation doses to tongue with different tongue positions during intensity-modulated radiation therapy (IMRT) in patients with head and neck squamous cell carcinoma (HNSCC) but who refused or did not tolerate an intraoral device (IOD), such as bite block, tongue blade, or mouthpiece.ResultsTongue volume outside of OC was 7.1 ± 3.8 cm3 (5.4 ± 2.6% of entire OC and 7.8 ± 3.1% of oral tongue) in IMRT-S. Dmean of OC was 34.9 ± 8.0 Gy and 31.4 ± 8.7 Gy with IMRT-N and IMRT-S, respectively (p < 0.001). OC volume receiving ≥ 36 Gy (V36) was 40.6 ± 16.9% with IMRT-N and 33.0 ± 17.0% with IMRT-S (p < 0.001). Dmean of tongue was 38.1 ± 7.9 Gy and 32.8 ± 8.8 Gy in IMRT-N and IMRT-S, respectively (p < 0.001). V15, V30, and V45 of tongue were significantly lower in IMRT-S (85.3 ± 15.0%, 50.6 ± 16.2%, 24.3 ± 16.0%, respectively) than IMRT-N (94.4 ± 10.6%, 64.7 ± 16.2%, 34.0 ± 18.6%, respectively) (all p < 0.001). Positional offsets of tongue during the course of IMRT-S was –0.1 ± 0.2 cm, 0.01 ± 0.1 cm, and –0.1 ± 0.2 cm (vertical, longitudinal, and lateral, respectively).Materials and Methods13 patients with HNSCC underwent CT-simulations both with a neutral tongue position and a stick-out tongue for IMRT planning (IMRT-N and IMRT-S, respectively). Planning objectives were to deliver 70 Gy, 63 Gy, and 56 Gy in 35 fractions to 95% of PTVs. Radiation Therapy Oncology Group (RTOG) recommended dose constraints were applied. Data are presented as mean ± standard deviation and compared using the student t-test.ConclusionsIMRT-S for patients with HNSCC who refused or could not tolerate an IOD has significant decreased radiation dose to the tongue than IMRT-N, which may potentially reduce RT related toxicity in tongue in selected patients.

Dosimetric advantage with IMRT-TO over IMRT-TI may potentially reduce post-IMRT swallowing dysfunction in selected patients with BOT cancer.

Between 12/1989 and 4/2011, we reviewed 425 patients with non-metastatic oral cavity cancer were treated with postoperative RT at our institution: 301 patients received adjuvant RT while 124 received salvage RT after tumor recurrence and salvage surgery. We estimated overall survival (OS) for the adjuvant cohort using the KM method for OS and cumulative incidence of LF, LRF, and DM using the Gray method. We subsequently performed a landmark analysis from 12 months post the initial surgery to reduce immortal time bias and compare the same outcomes in the adjuvant versus salvage cohort using the Cox proportional hazards regression model and Fine and Gray competing risks method. Results: The adjuvant cohort had significantly higher T stage than the salvage cohort, T1: 23% vs 66%; T2: 34% vs 23%; T3: 9% vs 3%; T4: 34% vs 2% p<0.0001. The adjuvant cohort also had significantly more locally advanced N stage than the salvage cohort, N0: 33% vs 93%; N1: 25% vs 2%; N2: 41% vs 3%, N3: 1% vs 0%. The median follow up for survivors was 77 months from the landmark, the 5 year LF, LRF, DM, and OS rates in the adjuvant cohort were 21.8%/28.7%/19%,/57% respectively. On MVA, patients who received salvage RT experienced significantly poorer OS compared to those that received adjuvant RT after adjusting for age and T stage (HR 1.84, 95% CI 1.26-2.70, pZ0.002). Salvage RT was also associated with significantly lower rates of LRC (HR 1.56, 95% CI 1.18-2.06, pZ0.002) and DM (HR 1.53, 95% CI 1.08-2.17, pZ0.02) on MVA. Conclusion: Salvage RT when adjusted for other factors results in significantly decreased LRC, higher rates of DM, and decreased OS as compared to adjuvant RT in OCC. Our study suggests that aggressive upfront loco-regional therapy represents the best opportunity to cure oral cavity carcinoma.

Purpose/Objective(s): Locally advanced squamous cell carcinoma of the oral cavity (LA-OCSCC) is most often treated with surgery followed by post-operative radiation therapy (S+PORT). Consequently, the effectiveness of organ preservation with concurrent chemoradiation (CRT) remains unclear. Here, we assessed the differences in survival between surgery and organ preservation in patients with LA-OCSCC treated with S+PORT or CRT. Materials/Methods: Using the National Cancer Database, we identified 6,900 patients with LA-OCSCC treated with S+PORT (n Z 4809) or CRT (n Z 2901) between 2004 and 2012. We used clinical stage grouping III-IVA to identify LA-OCSCC patients in order to avoid biases due to pathological staging in the S+PORT cohort. We excluded patients with T4b or N3 disease to avoid biases due to unresectable disease. Factors associated with use of chemoradiation were estimated using logistic regression analysis. Survival (OS) was estimated using Kaplan Meier methods and Cox proportional models. Comparisons between S+PORT and CRT were made in the entire cohort as well as using a propensity matched cohort of 1,136 patients. Results: Median follow-up was 17.3m for CRT vs. 25.6m for S+PORT (P < .0001). Compared to patients treated with S+PORT, patients receiving chemoradiation were more likely to be older than 60y, treated before 2007, live within 10 miles of the treating facility, treated at a non-Academic centers, have higher comorbidities, have T3-T4 tumors and have N2 nodal disease. Compared to CRT, S+PORT was associated with improved survival in all patients (3y OS: 53.9% for S+PORT vs. 37.8% for CRT; P < .0001) and in the propensity matched cohort (3y OS: 51.8% for S+PORT vs. 39.3% for CRT; P < .0001). S+PORT was associated with improved survival for T3-T4 tumors (3y OS: 49.7% for S+PORT vs. 36.0% for CRT; P < .0001) but was not associated with improved survival for T1-T2 tumors (3y OS: 59.1% for S+PORT vs. 53.5% for CRT; P Z .15). On multivariate analysis, improved OS was associated with S+PORT (HR: 0.66, 95% CI 0.61-0.71, P < .0001), age greater than 60y, treatment in 2010 or after, lower comorbidity scores and cT1-T2 disease. Conclusion: Compared to chemoradiation, surgery and post-operative radiation therapy was associated with improved survival for locally advanced oral cavity cancers, especially in T3-T4 disease. These data support the use of surgery as the initial treatment modality for operable oral cavity cancers.

this result was better explained by age (PZ.004) and total radiation received (PZ.007). Conclusion: In this data series, high-risk patients were significantly more likely to undergo a neck dissection after definitive chemoradiation treatment. However, risk group stratification appeared to have no prognostic value when examining DFS or OS among this group of patients with head and neck SCC.