Tags

Type your tag names separated by a space and hit enter

Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer.
Int J Radiat Oncol Biol Phys. 2008 Jun 01; 71(2):377-85.IJ

Abstract

PURPOSE

To determine the outcome of patients treated with intensity-modulated radiotherapy (IMRT) for head and neck cancer.

METHODS AND MATERIALS

We reviewed the charts of 100 consecutive patients treated with IMRT for squamous cell carcinoma of the oropharynx (64%), nasopharynx (16%), hypopharynx (14%), and larynx (6%). Most patients were treated with a concomitant boost schedule to 72 Gy. Of the 100 patients, 54 (54%) received adjuvant chemotherapy, mostly concurrent cisplatin. The dosimetry plans for patients with either locoregional failure or Grade 4-5 complications were reviewed and fused over the computed tomography images corresponding with the location of the event. Marginal failures were defined as those that occurred at a region of high-dose falloff, where conventional fields would have provided better coverage.

RESULTS

The median follow-up of living patients was 3.1 years (range, 1-5.2 years). The 3-year rate of local control, locoregional control, freedom from relapse, cause-specific survival, and overall survival for all patients was 89%, 87%, 72%, 78%, and 71%, respectively. The 3-year rate of freedom from relapse, cause-specific survival, and overall survival for the 64 oropharynx patients was 86%, 92%, and 84%, respectively. Of the 10 local failures, 2 occurred at the margin of the high-dose planning target volume. Both regional failures occurred within the planning target volume. No locoregional failures occurred outside the planning target volume. Of the 100 patients, 8 and 5 had Grade 4 and 5 complications from treatment, respectively. All patients with Grade 5 complications had received adjuvant chemotherapy. No attempt was made to discriminate between the complications from IMRT and other aspects of the patients' treatment.

CONCLUSION

Intensity-modulated radiotherapy did not compromise the outcome compared with what we have achieved with conventional techniques. The 2 cases of recurrence in the high-dose gradient region highlight the potential hazard of approaches that involve highly conformal dose distributions.

Authors+Show Affiliations

Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18164838

Citation

Schoenfeld, Gordon O., et al. "Patterns of Failure and Toxicity After Intensity-modulated Radiotherapy for Head and Neck Cancer." International Journal of Radiation Oncology, Biology, Physics, vol. 71, no. 2, 2008, pp. 377-85.
Schoenfeld GO, Amdur RJ, Morris CG, et al. Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008;71(2):377-85.
Schoenfeld, G. O., Amdur, R. J., Morris, C. G., Li, J. G., Hinerman, R. W., & Mendenhall, W. M. (2008). Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer. International Journal of Radiation Oncology, Biology, Physics, 71(2), 377-85. https://doi.org/10.1016/j.ijrobp.2007.10.010
Schoenfeld GO, et al. Patterns of Failure and Toxicity After Intensity-modulated Radiotherapy for Head and Neck Cancer. Int J Radiat Oncol Biol Phys. 2008 Jun 1;71(2):377-85. PubMed PMID: 18164838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patterns of failure and toxicity after intensity-modulated radiotherapy for head and neck cancer. AU - Schoenfeld,Gordon O, AU - Amdur,Robert J, AU - Morris,Christopher G, AU - Li,Jonathan G, AU - Hinerman,Russell W, AU - Mendenhall,William M, Y1 - 2007/12/31/ PY - 2007/08/21/received PY - 2007/10/09/revised PY - 2007/10/12/accepted PY - 2008/1/1/pubmed PY - 2008/6/25/medline PY - 2008/1/1/entrez SP - 377 EP - 85 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 71 IS - 2 N2 - PURPOSE: To determine the outcome of patients treated with intensity-modulated radiotherapy (IMRT) for head and neck cancer. METHODS AND MATERIALS: We reviewed the charts of 100 consecutive patients treated with IMRT for squamous cell carcinoma of the oropharynx (64%), nasopharynx (16%), hypopharynx (14%), and larynx (6%). Most patients were treated with a concomitant boost schedule to 72 Gy. Of the 100 patients, 54 (54%) received adjuvant chemotherapy, mostly concurrent cisplatin. The dosimetry plans for patients with either locoregional failure or Grade 4-5 complications were reviewed and fused over the computed tomography images corresponding with the location of the event. Marginal failures were defined as those that occurred at a region of high-dose falloff, where conventional fields would have provided better coverage. RESULTS: The median follow-up of living patients was 3.1 years (range, 1-5.2 years). The 3-year rate of local control, locoregional control, freedom from relapse, cause-specific survival, and overall survival for all patients was 89%, 87%, 72%, 78%, and 71%, respectively. The 3-year rate of freedom from relapse, cause-specific survival, and overall survival for the 64 oropharynx patients was 86%, 92%, and 84%, respectively. Of the 10 local failures, 2 occurred at the margin of the high-dose planning target volume. Both regional failures occurred within the planning target volume. No locoregional failures occurred outside the planning target volume. Of the 100 patients, 8 and 5 had Grade 4 and 5 complications from treatment, respectively. All patients with Grade 5 complications had received adjuvant chemotherapy. No attempt was made to discriminate between the complications from IMRT and other aspects of the patients' treatment. CONCLUSION: Intensity-modulated radiotherapy did not compromise the outcome compared with what we have achieved with conventional techniques. The 2 cases of recurrence in the high-dose gradient region highlight the potential hazard of approaches that involve highly conformal dose distributions. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/18164838/Patterns_of_failure_and_toxicity_after_intensity_modulated_radiotherapy_for_head_and_neck_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(07)04423-9 DB - PRIME DP - Unbound Medicine ER -