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. 2023 Oct 31:13:1272856.
doi: 10.3389/fonc.2023.1272856. eCollection 2023.

Outcomes among oropharyngeal and oral cavity cancer patients treated with postoperative volumetric modulated arctherapy

Cécile Mione #  1 , Mélanie Casile #  2   3   4 , Juliette Moreau  1 , Jessica Miroir  1 , Ioana Molnar  2   3   4 , Emmanuel Chautard  1   2 , Maureen Bernadach  3   4   5 , Myriam Kossai  2   6 , Nicolas Saroul  7 , F Martin  1 , Nathalie Pham-Dang  8 , Michel Lapeyre #  1 , Julian Biau #  1   2
Affiliations

Outcomes among oropharyngeal and oral cavity cancer patients treated with postoperative volumetric modulated arctherapy

Cécile Mione et al. Front Oncol. .

Abstract

Background: Presently, there are few published reports on postoperative radiation therapy for oropharyngeal and oral cavity cancers treated with IMRT/VMAT technique. This study aimed to assess the oncological outcomes of this population treated with postoperative VMAT in our institution, with a focus on loco-regional patterns of failure.

Material and methods: Between 2011 and 2019, 167 patients were included (40% of oropharyngeal cancers, and 60% of oral cavity cancers). The median age was 60 years. There was 64.2% of stage IV cancers. All patients had both T and N surgery. 34% had a R1 margin, 42% had perineural invasion. 72% had a positive neck dissection and 42% extranodal extension (ENE). All patients were treated with VMAT with simultaneous integrated boost with three dose levels: 66Gy in case of R1 margin and/or ENE, 59.4-60Gy on the tumor bed, and 54Gy on the prophylactic areas. Concomittant cisplatin was administrated concomitantly when feasible in case of R1 and/or ENE.

Results: The 1- and 2-year loco-regional control rates were 88.6% and 85.6% respectively. Higher tumor stage (T3/T4), the presence of PNI, and time from surgery >45 days were significant predictive factors of worse loco-regional control in multivariate analysis (p=0.02, p=0.04, and p=0.02). There were 17 local recurrences: 11 (64%) were considered as infield, 4 (24%) as marginal, and 2 (12%) as outfield. There were 9 regional recurrences only, 8 (89%) were considered as infield, and 1 (11%) as outfield. The 1- and 2-year disease-free survival (DFS) rates were 78.9% and 71.8% respectively. The 1- and 2-year overall survival (OS) rates were 88.6% and 80% respectively. Higher tumor stage (T3/T4) and the presence of ENE were the two prognostic factors significantly associated with worse DFS and OS in multivariate analysis.

Conclusion: Our outcomes for postoperative VMAT for oral cavity and oropharyngeal cancers are encouraging, with high rates of loco-regional control. However, the management of ENE still seems challenging.

Keywords: VMAT; head and neck cancer; post-operative; radiotherapy; recurrences.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Loco-regional control among (A) the entire population, and (B) according to tumor staging, (C) the presence of perineural invasion, and (D) Time from surgery to radiotherapy.
Figure 2
Figure 2
Metastasis-free survival among (A) the entire population, and (B) according to the presence of extranodal extension.
Figure 3
Figure 3
Disease-free survival among (A) the entire population, and (B) according to tumor staging, and (C) the presence of extranodal extension.
Figure 4
Figure 4
Overall survival among (A) the entire population, and (B) according to tumor staging, and (C) the presence of extranodal extension.
See this image and copyright information in PMC

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