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. 2007 Apr 12:2:16.
doi: 10.1186/1748-717X-2-16.

IMRT in oral cavity cancer

Gabriela Studer  1 , Roger A Zwahlen, Klaus W Graetz, Bernard J Davis, Christoph Glanzmann
Affiliations

IMRT in oral cavity cancer

Gabriela Studer et al. Radiat Oncol. .

Abstract

Background: Except for early T1,2 N0 stages, the prognosis for patients with oral cavity cancer (OCC) is reported to be worse than for carcinoma in other sites of the head and neck (HNC). The aim of this work was to assess disease outcome in OCC following IMRT.Between January 2002 and January 2007, 346 HNC patients have been treated with curative intensity modulated radiation therapy (IMRT) at the Department of Radiation Oncology, University Hospital Zurich. Fifty eight of these (16%) were referred for postoperative (28) or definitive (30) radiation therapy of OCC.40 of the 58 OCC patients (69%) presented with locally advanced T3/4 or recurred lesions. Doses between 60 and 70 Gy were applied, combined with simultaneous cisplatin based chemotherapy in 78%. Outcome analyses were performed using Kaplan Meier curves.In addition, comparisons were performed between this IMRT OCC cohort and historic in-house cohorts of 33 conventionally irradiated (3DCRT) and 30 surgery only patients treated over the last 10 years.

Results: OCC patients treated with postoperative IMRT showed the highest local control (LC) rate of all assessed treatment sequence subgroups (92% LC at 2 years). Historic postoperative 3DCRT patients and patients treated with surgery alone reached LC rates of approximately 70-80%. Definitively irradiated patients revealed poorest LC rates with approximately 30 and 40% following 3DCRT and IMRT, respectively.T1 stage resulted in an expectedly significantly higher LC rate (95%, n = 19, p < 0.05) than T2-4 and recurred stages (LC approximately 50-60%, n = 102).Analyses according to the diagnosis revealed significantly lower LC in OCC following definitive IMRT than that in pharyngeal tumors treated with definitive IMRT in the same time period (43% vs 82% at 2 years, p < 0.0001), while the LC rate of OCC following postoperative IMRT was as high as in pharyngeal tumors treated with postoperative IMRT (>90% at 2 years).

Conclusion: Postoperative IMRT of OCC resulted in the highest local control rate of the assessed treatment subgroups. In conclusion, generous indication for IMRT following surgical treatment is recommended in OCC cases with unfavourable features like tight surgical margin, nodal involvement, primary tumor stage >T1N0, or already recurred disease, respectively.Loco-regional outcome of OCC following definitive IMRT remained unsatisfactory, comparable to that following definitive 3DCRT.

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Figures

Figure 1
Figure 1
Local (LC), nodal (NC), distant control (DC), overall survival (OAS), and disease free survival (DFS) of the entire analysed oral cancer cavity cohort (N = 121 patients).
Figure 2
Figure 2
Local control rates of all patients, analysed according to the T-stages. T1 staged tumors showed a superior local outcome (p = 0.045), while all other stages including recurrences, did not differ.
Figure 3
Figure 3
Postoperative IMRT: identically high local control rates in 28 oral cavity cancer patients and 42 patients treated for a squamous cell carcinoma located in the pharynx (nasopharyngeal tumors excluded).
Figure 4
Figure 4
Definitive IMRT: significantly different local control rates in favour to 174 patients treated for squamous cell carcinoma of the pharynx (nasopharyngeal tumors excluded) vs 30 oral cavity cancer (OCC) patients (p < 0.0001) – despite of an identical tumor volume load in the two groups, with mean/median 45/41 cc and 46/39 cc.
See this image and copyright information in PMC

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