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Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma--the University of Iowa experience.
Int J Radiat Oncol Biol Phys. 2005 Oct 01; 63(2):410-21.IJ

Abstract

PURPOSE

To review the University of Iowa experience with intensity-modulated radiotherapy (IMRT) in the treatment of head-and-neck squamous cell carcinoma.

METHODS AND MATERIALS

From October 1999 to April 2004, 151 patients with head-and-neck squamous cell carcinoma were treated with IMRT for curative intent. One patient was lost to follow-up 2 months after treatment and therefore excluded from analysis. Of the remaining 150 patients, 99 were treated with definitive IMRT, and 51 received postoperative IMRT. Sites included were nasopharynx, 5; oropharynx, 56; larynx, 33; oral cavity, 29; hypopharynx, 8; nasal cavity/paranasal sinus, 8; and unknown primary, 11. None of the patients treated with postoperative IMRT received chemotherapy. Of 99 patients who had definitive IMRT, 68 patients received concurrent cisplatin-based chemotherapy. One patient received induction cisplatin-based chemotherapy, but no concurrent chemotherapy was given. Three clinical target volumes (CTV1, CTV2, and CTV3) were defined. The prescribed doses to CTV1, CTV2, and CTV3 in the definitive cohort were 70-74 Gy, 60 Gy, and 54 Gy, respectively. For high-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 64-66 Gy, 60 Gy, and 54 Gy, respectively. For intermediate-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 60 Gy, 60 Gy, and 54 Gy.

RESULTS

The median follow-up was 18 months (range, 2-60 months). All living patients were followed for at least 6 months. There were 11 local-regional failures: 7 local failures, 3 regional failures, and 1 failure both in the primary tumor and regional lymph node. There were 16 patients who failed distantly, either with distant metastasis or new lung primaries. The 2-year overall survival, local progression-free survival, locoregional progression-free survival, and distant disease-free survival rates were 85%, 94%, 92%, and 87%, respectively. The median time from treatment completion to local-regional recurrence was 4.7 months (range, 1.8 to 15.6 months). Only one marginal failure was noted in a patient who had extensive tonsil cancer with tumor extension into the orbit and cavernous sinus. Patients with oropharyngeal cancer did significantly better than patients with oral cavity and laryngeal cancer, with a 2-year local-regional control rate of 98%, compared with 78% for oral cavity cancer and 85% for laryngeal cancer (p = 0.005). There was no significant difference in local-regional control for patients who received postoperative radiation or definitive radiation (p = 0.339) and for patients who had chemotherapy or not (p = 0.402). Neither T stage nor N stage had a significant effect on local-regional control (p = 0.722 and 0.712, respectively).

CONCLUSIONS

Our results have confirmed the effectiveness of IMRT in head-and-neck cancer. It offers excellent outcomes in local-regional control and overall survival. More studies are necessary to further improve the outcomes of laryngeal cancer as well as oral cavity cancer.

Authors+Show Affiliations

Department of Radiation Oncology, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242, USA. min-yao@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16168834

Citation

Yao, Min, et al. "Intensity-modulated Radiation Treatment for Head-and-neck Squamous Cell Carcinoma--the University of Iowa Experience." International Journal of Radiation Oncology, Biology, Physics, vol. 63, no. 2, 2005, pp. 410-21.
Yao M, Dornfeld KJ, Buatti JM, et al. Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma--the University of Iowa experience. Int J Radiat Oncol Biol Phys. 2005;63(2):410-21.
Yao, M., Dornfeld, K. J., Buatti, J. M., Skwarchuk, M., Tan, H., Nguyen, T., Wacha, J., Bayouth, J. E., Funk, G. F., Smith, R. B., Graham, S. M., Chang, K., & Hoffman, H. T. (2005). Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma--the University of Iowa experience. International Journal of Radiation Oncology, Biology, Physics, 63(2), 410-21.
Yao M, et al. Intensity-modulated Radiation Treatment for Head-and-neck Squamous Cell Carcinoma--the University of Iowa Experience. Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):410-21. PubMed PMID: 16168834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensity-modulated radiation treatment for head-and-neck squamous cell carcinoma--the University of Iowa experience. AU - Yao,Min, AU - Dornfeld,Kenneth J, AU - Buatti,John M, AU - Skwarchuk,Mark, AU - Tan,Huaming, AU - Nguyen,Thanh, AU - Wacha,Judith, AU - Bayouth,John E, AU - Funk,Gerry F, AU - Smith,Russell B, AU - Graham,Scott M, AU - Chang,Kristi, AU - Hoffman,Henry T, PY - 2004/12/17/received PY - 2005/02/08/revised PY - 2005/02/14/accepted PY - 2005/9/20/pubmed PY - 2005/11/15/medline PY - 2005/9/20/entrez SP - 410 EP - 21 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 63 IS - 2 N2 - PURPOSE: To review the University of Iowa experience with intensity-modulated radiotherapy (IMRT) in the treatment of head-and-neck squamous cell carcinoma. METHODS AND MATERIALS: From October 1999 to April 2004, 151 patients with head-and-neck squamous cell carcinoma were treated with IMRT for curative intent. One patient was lost to follow-up 2 months after treatment and therefore excluded from analysis. Of the remaining 150 patients, 99 were treated with definitive IMRT, and 51 received postoperative IMRT. Sites included were nasopharynx, 5; oropharynx, 56; larynx, 33; oral cavity, 29; hypopharynx, 8; nasal cavity/paranasal sinus, 8; and unknown primary, 11. None of the patients treated with postoperative IMRT received chemotherapy. Of 99 patients who had definitive IMRT, 68 patients received concurrent cisplatin-based chemotherapy. One patient received induction cisplatin-based chemotherapy, but no concurrent chemotherapy was given. Three clinical target volumes (CTV1, CTV2, and CTV3) were defined. The prescribed doses to CTV1, CTV2, and CTV3 in the definitive cohort were 70-74 Gy, 60 Gy, and 54 Gy, respectively. For high-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 64-66 Gy, 60 Gy, and 54 Gy, respectively. For intermediate-risk postoperative IMRT, the prescribed doses to CTV1, CTV2, and CTV3 were 60 Gy, 60 Gy, and 54 Gy. RESULTS: The median follow-up was 18 months (range, 2-60 months). All living patients were followed for at least 6 months. There were 11 local-regional failures: 7 local failures, 3 regional failures, and 1 failure both in the primary tumor and regional lymph node. There were 16 patients who failed distantly, either with distant metastasis or new lung primaries. The 2-year overall survival, local progression-free survival, locoregional progression-free survival, and distant disease-free survival rates were 85%, 94%, 92%, and 87%, respectively. The median time from treatment completion to local-regional recurrence was 4.7 months (range, 1.8 to 15.6 months). Only one marginal failure was noted in a patient who had extensive tonsil cancer with tumor extension into the orbit and cavernous sinus. Patients with oropharyngeal cancer did significantly better than patients with oral cavity and laryngeal cancer, with a 2-year local-regional control rate of 98%, compared with 78% for oral cavity cancer and 85% for laryngeal cancer (p = 0.005). There was no significant difference in local-regional control for patients who received postoperative radiation or definitive radiation (p = 0.339) and for patients who had chemotherapy or not (p = 0.402). Neither T stage nor N stage had a significant effect on local-regional control (p = 0.722 and 0.712, respectively). CONCLUSIONS: Our results have confirmed the effectiveness of IMRT in head-and-neck cancer. It offers excellent outcomes in local-regional control and overall survival. More studies are necessary to further improve the outcomes of laryngeal cancer as well as oral cavity cancer. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/16168834/Intensity_modulated_radiation_treatment_for_head_and_neck_squamous_cell_carcinoma__the_University_of_Iowa_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(05)00352-4 DB - PRIME DP - Unbound Medicine ER -