Intensity-modulated radiotherapy for oral cavity squamous cell carcinoma

Patterns of failure and predictors of local control

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

Research output: Contribution to journalArticle

41 Citations (Scopus)

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: 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.

Original languageEnglish (US)
Pages (from-to)1412-1422
Number of pages11
JournalInternational Journal of Radiation Oncology Biology Physics
Volume80
Issue number5
DOIs
StatePublished - Aug 1 2011
Externally publishedYes

Fingerprint

Intensity-Modulated Radiotherapy
Mouth
Squamous Cell Carcinoma
radiation therapy
cancer
cavities
surgery
predictions
metastasis
intervals
toxicity
Neoplasm Metastasis
delineation
margins
grade
therapy
Recurrence
dosage
Survival

Keywords

  • Intensity-modulated radiotherapy
  • Oral cavity
  • Squamous cell carcinoma

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

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 J.; Fischbein, Nancy J.; Chang, Daniel T.

In: International Journal of Radiation Oncology Biology Physics, Vol. 80, No. 5, 01.08.2011, p. 1412-1422.

Research output: Contribution to journalArticle

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. / Intensity-modulated radiotherapy for oral cavity squamous cell carcinoma : Patterns of failure and predictors of local control. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 80, No. 5. pp. 1412-1422.
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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: 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.",
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AU - Maxim, Peter G.

AU - Murphy, James D.

AU - Hsu, Annie

AU - Loo, Billy W.

AU - Kaplan, Michael J.

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AU - Chang, Daniel T.

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AB - 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.

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