Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma: Patterns of Failure and Predictors of Local Control

Daly, Megan E.; Le, Quynh‐Thu; Kozak, Margaret M.; Maxim, Peter G.; Murphy, James D.; Hsu, Annie; Loo, Billy W.; Kaplan, Michael; Fischbein, Nancy J.; Chang, Daniel T.

doi:10.1016/j.ijrobp.2010.04.031

Cited by 66 publications

(53 citation statements)

References 30 publications

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“…The most frequent pattern of loco-regional failure in this study was in-field recurrence; marginal and out-field recurrence were not frequent, accounting for only 4% and 6% of all the patients, respectively, which was consistent with the previous findings (10,11,(21)(22)(23), listed in Table 5 (7,10,11,19,21,23). The in-field recurrence rate in this study was relatively high compared to those in the previous reports (7,10,11,19,21,23).…”

Section: Discussionsupporting

confidence: 91%

“…Thus, the treatment outcomes seemed satisfactory and comparable to previous reports (10,11,(21)(22)(23), even though nearly a half of the patients had primary cancer of the oral cavity, whose outcomes are typically inferior to those of other head and neck cancers (11,24).…”

Section: Discussionsupporting

confidence: 83%

“…However, IMRT has a very sharp dose gradient between the target and the surrounding normal tissues (7)(8)(9), which could lead to marginal recurrence, especially when IMRT is used in postoperative settings where prior surgical manipulation might have dispersed microscopic disease widely over the surgical bed (10)(11)(12). In addition, definition of the target tends to be more difficult in the adjuvant postoperative setting as compared to that in the definitive radiotherapy setting, because of the lack of gross visible tumor tissue and architectural distortion by surgery (13).…”

Section: Introductionmentioning

confidence: 99%

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Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer

Ooishi

Motegi

Kawashima

et al. 2016

Japanese Journal of Clinical Oncology

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer

Ooishi

Motegi

Kawashima

et al. 2016

Japanese Journal of Clinical Oncology

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“…This is comparable with western reports where median package times of 5.9-7 weeks have been reported. 11,13 However, to further reduce this delay, we have When ,20% of the recurrent volume lies inside the 95% isodose line it is classified as an outfield recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 While several authors have presented results of adjuvant radiotherapy using IMRT for oral cavity malignancies, no Indian series has been reported till date. [9][10][11][12][13][14][15][16] Since April 2012, we have been treating patients with head-neck cancers regularly with Rapid Arc IMRT unless the patient had financial difficulties. A high risk of recurrence in the setting of postoperative IMRT has been reported by Turaka et al, 17 who reported that all three marginal failures in their cohort were noticed in patients receiving post-operative radiotherapy.…”

mentioning

confidence: 99%

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

Chakraborty

Patil²,

Babu³

et al. 2015

BJR

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Cite this article as: Chakraborty S, Patil VM, Babu S, Muttath G, Thiagarajan SK. Locoregional recurrences after post-operative volumetric modulated arc radiotherapy (VMAT) in oral cavity cancers in a resource constrained setting: experience and lessons learned. Br J Radiol 2015;88:20140795. FULL PAPER Locoregional recurrences after post-operative volumetric modulated arc radiotherapy (VMAT) in oral cavity cancers in a resource constrained setting: experience and lessons learned Results: 75 patients with a median follow-up of 24 months were analysed. 41 (55%) patients had oral tongue cancers and 52 (69%) of the patients had Stage IVA cancers. The 2-year locoregional recurrence-free survival, diseasefree survival and overall survival were 88.9%, 82.1% and 80.5%, respectively. With a median time to failure of 6.5 months, five infield and three outfield failures were identified. Conclusion: A relatively low rate of outfield failure and lack of marginal failure attests to the efficacy of VMAT in such patients. Modifications to our existing target delineation policy have been proposed. Advances in knowledge: The use of standardized target delineation methods allows safe use of VMAT IMRT even in resource-constrained settings.

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Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma

Hosni

Huang

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Surgery and postoperative IMRT with or without concurrent chemotherapy achieved encouraging outcomes. The clinicopathological characteristics of DOF and DM with locoregional failure were similar. Patients with G2-3, pN2-3, and extracapsullar extension (all together) have higher risk of DOF. Both pN2-3 and G2-3 were independent predictors of DM. Patients with these risk factors may be candidates for prospective clinical trials of intensified therapy or surveillance strategies.

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Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma: Patterns of Failure and Predictors of Local Control

Cited by 66 publications

References 30 publications

Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer

Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer

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

Distant Metastases Following Postoperative Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma

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