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. 2006 Oct 19:1:40.
doi: 10.1186/1748-717X-1-40.

Postoperative IMRT in head and neck cancer

Gabriela Studer  1 , Katrin Furrer, Bernard J Davis, Sandro S Stoeckli, Roger A Zwahlen, Urs M Luetolf, Christoph Glanzmann
Affiliations

Postoperative IMRT in head and neck cancer

Gabriela Studer et al. Radiat Oncol. .

Abstract

Background: Aim of this work was to assess loco-regional disease control in head and neck cancer (HNC) patients treated with postoperative intensity modulated radiation therapy (pIMRT). For comparative purposes, risk features of our series have been analysed with respect to histopathologic adverse factors. Results were compared with an own historic conventional radiation (3DCRT) series, and with 3DCRT and pIMRT data from other centres.Between January 2002 and August 2006, 71 patients were consecutively treated with pIMRT for a squamous cell carcinoma (SCC) of the oropharynx (32), oral cavity (22), hypopharynx (7), larynx (6), paranasal sinus (3), and an unknown primary, respectively. Mean and median follow up was 19 months (2-48), and 17.6 months. 83% were treated with IMRT-chemotherapy. Mean prescribed dose was 66.3 Gy (60-70), delivered with doses per fraction of 2-2.3 Gy, respectively.

Results: 2-year local, nodal, and distant control rates were 95%, 91%, and 96%, disease free and overall survival 90% and 83%, respectively. The corresponding survival rates for the subgroup of patients with a follow up time >12 months (n = 43) were 98%, 95%, 98%, 93%, and 88%, respectively. Distribution according to histopathologic risk features revealed 15% and 85% patients with intermediate and high risk, respectively. All loco-regional events occurred in the high risk subgroup.

Conclusion: Surgery followed by postoperative IMRT in patients with substantial risk for recurrence resulted in high loco-regional tumor control rates compared with large prospective 3DCRT trials.

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Figures

Figure 1
Figure 1
a: 2-year actuarial local (LC, 95%), nodal (NC, 91%), distant control (DC, 96%), and disease free (DFS, 90%) and overall survival rate (OAS, 83%) in 71 postoperative IMRT patients.b: 2-year actuarial local (LC, 98%), nodal (NC, 95%), distant control (DC, 98%), and disease free (DFS, 93%) and overall survival rate (OAS, 88%) in 43/71 postoperative IMRT patients with a follow up period of >12 months.
Figure 2
Figure 2
Superficial nodal recurrence (ipsilateral dorsolateral node) in a patient with a pT2 pN2b supraglottic larynx carcinoma. Preoperative diagnostic images did not show any suspicious superficial nodes, nor were any enlarged nodes visible in the postoperative planning computed tomography a: IMRT treatment plan, PTV1 (black line): 'build up' effect in the skin/subcutaneous region of interest (ROI, white dotted line) which was not intended to be included into the PTV1. b: posttreatment follow up computed tomography scan revealed a superficial lymph node metastasis (ROI), located in the former 'build up' area
See this image and copyright information in PMC

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