Follow up after IMRT in oral cavity cancer: update

Abstract

PurposeExcept for early stages (T1/2 N0), the prognosis for patients with oral cavity cancer (OCC) is known to be worse than for those with pharyngeal carcinoma. While definitive intensity modulated radiation therapy (IMRT)-chemotherapy affords loco-regional control rates (LRC) of approximately 80% in advanced pharyngeal cancer, corresponding rates are reported to be much lower for OCC. The aim of this work was to evaluate loco-regional disease control and overall survival (OAS) in a relatively large OCC patient cohort treated in the IMRT era.Methods and materialsBetween October 2002 and June 2011, 160 OCC patients were treated with curative intention IMRT at our department. 122 patients (76%) were referred with primary disease and 38 patients (24%) with a recurrent OCC at least 3 months after surgery alone. Definitive IMRT was performed in 44/160 patients (28%), whilst 116 patients underwent previous surgery. Simultaneous systemic therapy was administered in 72%.ResultsPatients with postoperative IMRT (+/−systemic therapy) with R0-1 status (n = 99) reached significantly higher LRC/OAS rates than patients following IMRT for macroscopic disease (n = 61), with 84%/80% versus 38%/33% at 3 years, respectively (p < 0.0001). This was found in patients treated for initial, as well as recurrent, disease. Less than 2% persisting grade 3/4 late effects were observed.ConclusionsIMRT for R0-1 situations translated into a highly significant superior LRC and OAS compared to the IMRT cohort treated for macroscopic disease. Treatment was well tolerated.

Definitive chemoradiation for primary oral cavity carcinoma: A single institution experience

“…The rate of osteoradionecrosis in the present study was 6.8%, which falls in line with other studies – ranging from 5.9% to 18.4% – in which both conventional and IMRT were utilized [9,25]. However, as IMRT has been shown to afford lower rates osteoradionecrosis, rates in modern IMRT series have dropped to between 1% and 14% [14,15,26,27]. In patients who are surgical candidates, however, post-operative IMRT rather than IMRT alone may provide the greatest benefit [15].…”

“…The 5-year OS was 15%, which was lower than other recent studies examining similarly large proportions of advanced-stage cancer, with OS rates between 37% and 76% (Table 5) [9,14,15]. Importantly, our series contained a significant proportion of patients with medically unresectable disease or who were medically unfit for surgery.…”

“…However, as IMRT has been shown to afford lower rates osteoradionecrosis, rates in modern IMRT series have dropped to between 1% and 14% [14,15,26,27]. In patients who are surgical candidates, however, post-operative IMRT rather than IMRT alone may provide the greatest benefit [15]. For reasons not clearly defined, however, the rates of LRC for OCC treated with either definitive or post-operative IMRT are generally poorer than those of OPC [15,28].…”

“…In patients who are surgical candidates, however, post-operative IMRT rather than IMRT alone may provide the greatest benefit [15]. For reasons not clearly defined, however, the rates of LRC for OCC treated with either definitive or post-operative IMRT are generally poorer than those of OPC [15,28]. …”

Locoregional recurrences after post-operative volumetric modulated arc radiotherapy (VMAT) in oral cavity cancers in a resource constrained setting: experience and lessons learned

“…This may account for the low regional recurrence rate seen in the present series (8%) unlike the 16-17% rates experienced in some western series where elective nodal radiation was either omitted or given selectively to patients with N0-1 disease. 23,29 The majority of our recurrences were in the form of regional nodal recurrences. This replicates the experience of Chan et al 23 where isolated local recurrence was seen in only one patient.…”