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Outcome and patterns of failure after postoperative intensity modulated radiotherapy for locally advanced or high-risk oral cavity squamous cell carcinoma

Andreas Geretschläger1, Beat Bojaxhiu1, Susanne Crowe2, Andreas Arnold3, Peter Manser1, Wock Hallermann4, Daniel M Aebersold1 and Pirus Ghadjar1*

Author Affiliations

1 Department of Radiation Oncology and Division of Medical Radiation Physics, Bern University Hospital, Freiburgstrasse, 3010, Bern, Switzerland

2 SAKK Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland

3 Department of Otorhinolaryngology, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland

4 Department of Craniomaxillofacial Surgery, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland

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Radiation Oncology 2012, 7:175  doi:10.1186/1748-717X-7-175

Published: 22 October 2012

Abstract

Background

To determine the outcome and patterns of failure in oral cavity cancer (OCC) patients after postoperative intensity modulated radiotherapy (IMRT) with concomitant systemic therapy.

Methods

All patients with locally advanced (AJCC stage III/IV) or high-risk OCC (AJCC stage II) who underwent postoperative IMRT at our institution between December 2006 and July 2010 were retrospectively analyzed. The primary endpoint was locoregional recurrence-free survival (LRRFS). Secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), acute and late toxicities.

Results

Overall 53 patients were analyzed. Twenty-three patients (43%) underwent concomitant chemotherapy with cisplatin, two patients with carboplatin (4%) and four patients were treated with the monoclonal antibody cetuximab (8%).

At a median follow-up of 2.3 (range, 1.1–4.6) years the 3-year LRRFS, DMFS and OS estimates were 79%, 90%, and 73% respectively. Twelve patients experienced a locoregional recurrence. Eight patients, 5 of which had both a flap reconstruction and extracapsular extension (ECE), showed an unusual multifocal pattern of recurrence. Ten locoregional recurrences occurred marginally or outside of the high-risk target volumes. Acute toxicity grades of 2 (27%) and 3 (66%) and late toxicity grades of 2 (34%) and 3 (11%) were observed.

Conclusion

LRRFS after postoperative IMRT is satisfying and toxicity is acceptable. The majority of locoregional recurrences occurred marginally or outside of the high-risk target volumes. Improvement of high-risk target volume definition especially in patients with flap reconstruction and ECE might transfer into better locoregional control.

Keywords:
Head and neck cancer; IMRT; Oral cavity; Outcome; Postoperative