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

Abstract

Purpose: Few studies have evaluated the use of intensity-modulated radiotherapy (IMRT) for squamous cell carcinoma (SCC) of the oral cavity (OC). We report clinical outcomes and failure patterns for these patients. Methods and Materials: Between October 2002 and June 2009, 37 patients with newly diagnosed SCC of the OC underwent postoperative (30) or definitive (7) IMRT. Twenty-five patients (66%) received systemic therapy. The median follow-up was 38 months (range, 10-87 months). The median interval from surgery to RT was 5.9 weeks (range, 2.1-10.7 weeks). Results: Thirteen patients experienced local-regional failure at a median of 8.1 months (range, 2.4-31.9 months), and 2 additional patients experienced local recurrence between surgery and RT. Seven local failures occurred in-field (one with simultaneous nodal and distant disease) and two at the margin. Four regional failures occurred, two in-field and two out-of-field, one with synchronous metastases. Six patients experienced distant failure. The 3-year actuarial estimates of local control, local-regional control, freedom from distant metastasis, and overall survival were 67%, 53%, 81%, and 60% among postoperative patients, respectively, and 60%, 60%, 71%, and 57% among definitive patients. Four patients developed Grade {>=}2 chronic toxicity. Increased surgery to RT interval predicted for decreased LRC (p = 0.04). Conclusions:more » Local-regional control for SCC of the OC treated with IMRT with or without surgery remains unsatisfactory. Definitive and postoperative IMRT have favorable toxicity profiles. A surgery-to-RT interval of <6 weeks improves local-regional control. The predominant failure pattern was local, suggesting that both improvements in target delineation and radiosensitization and/or dose escalation are needed.« less

Authors:
; ; ; ; ; ;  [1];  [2];  [3];  [1]
  1. Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA (United States)
  2. Department of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, Stanford, CA (United States)
  3. Department of Radiology, Stanford University Medical Center, Stanford, CA (United States)
Publication Date:
OSTI Identifier:
21587672
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 80; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2010.04.031; PII: S0360-3016(10)00608-5; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; METASTASES; ORAL CAVITY; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY; DIGESTIVE SYSTEM; DISEASES; DOSES; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; RADIOLOGY; THERAPY

Citation Formats

Daly, Megan E., Le, Quynh-Thu, Kozak, Margaret M., Maxim, Peter G., Murphy, James D., Hsu, Annie, Loo, Billy W., Kaplan, Michael J., Fischbein, Nancy J., and Chang, Daniel T., E-mail: dtchang@stanford.edu. Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma: Patterns of Failure and Predictors of Local Control. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.04.031.
Daly, Megan E., Le, Quynh-Thu, Kozak, Margaret M., Maxim, Peter G., Murphy, James D., Hsu, Annie, Loo, Billy W., Kaplan, Michael J., Fischbein, Nancy J., & Chang, Daniel T., E-mail: dtchang@stanford.edu. Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma: Patterns of Failure and Predictors of Local Control. United States. doi:10.1016/j.ijrobp.2010.04.031.
Daly, Megan E., Le, Quynh-Thu, Kozak, Margaret M., Maxim, Peter G., Murphy, James D., Hsu, Annie, Loo, Billy W., Kaplan, Michael J., Fischbein, Nancy J., and Chang, Daniel T., E-mail: dtchang@stanford.edu. Mon . "Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma: Patterns of Failure and Predictors of Local Control". United States. doi:10.1016/j.ijrobp.2010.04.031.
@article{osti_21587672,
title = {Intensity-Modulated Radiotherapy for Oral Cavity Squamous Cell Carcinoma: Patterns of Failure and Predictors of Local Control},
author = {Daly, Megan E. and Le, Quynh-Thu and Kozak, Margaret M. and Maxim, Peter G. and Murphy, James D. and Hsu, Annie and Loo, Billy W. and Kaplan, Michael J. and Fischbein, Nancy J. and Chang, Daniel T., E-mail: dtchang@stanford.edu},
abstractNote = {Purpose: Few studies have evaluated the use of intensity-modulated radiotherapy (IMRT) for squamous cell carcinoma (SCC) of the oral cavity (OC). We report clinical outcomes and failure patterns for these patients. Methods and Materials: Between October 2002 and June 2009, 37 patients with newly diagnosed SCC of the OC underwent postoperative (30) or definitive (7) IMRT. Twenty-five patients (66%) received systemic therapy. The median follow-up was 38 months (range, 10-87 months). The median interval from surgery to RT was 5.9 weeks (range, 2.1-10.7 weeks). Results: Thirteen patients experienced local-regional failure at a median of 8.1 months (range, 2.4-31.9 months), and 2 additional patients experienced local recurrence between surgery and RT. Seven local failures occurred in-field (one with simultaneous nodal and distant disease) and two at the margin. Four regional failures occurred, two in-field and two out-of-field, one with synchronous metastases. Six patients experienced distant failure. The 3-year actuarial estimates of local control, local-regional control, freedom from distant metastasis, and overall survival were 67%, 53%, 81%, and 60% among postoperative patients, respectively, and 60%, 60%, 71%, and 57% among definitive patients. Four patients developed Grade {>=}2 chronic toxicity. Increased surgery to RT interval predicted for decreased LRC (p = 0.04). Conclusions: Local-regional control for SCC of the OC treated with IMRT with or without surgery remains unsatisfactory. Definitive and postoperative IMRT have favorable toxicity profiles. A surgery-to-RT interval of <6 weeks improves local-regional control. The predominant failure pattern was local, suggesting that both improvements in target delineation and radiosensitization and/or dose escalation are needed.},
doi = {10.1016/j.ijrobp.2010.04.031},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 80,
place = {United States},
year = {2011},
month = {8}
}