Impact of postoperative daily image-guided intensity-modulated radiotherapy on overall and local progression-free survival in patients with oral cavity cancer.

Chen-Hsi Hsieh,Hui-Ju Tien,Yu-Chuen Huang,Li-Ying Wang,Yu-Chin Lin,Pei-Wei Shueng,Li-Jen Liao,Le-Jung Wu,Wu-Chia Lo

doi:10.1186/s12885-016-2165-9

Abstract

BackgroundWe compared the outcome of patients who received non-image-guided intensity-modulated radiotherapy (IMRT) with those who received helical tomotherapy (HT), a daily image-guided radiotherapy (IGRT), after surgery for oral cavity cancer (OCC).MethodsDuring the period November 2006 to December 2013, a total of 152 postoperative OCC patients underwent either IMRT (n = 79) or daily IGRT (n = 73) 4 to 6 weeks after surgery. Patients in the IMRT group received 6 MV photon beams to 7 fields and those in the IGRT group received daily fractions of 1.8 or 2 Gy on five consecutive days.ResultsPatients who received daily IGRT had higher 5-year overall survival than those who received IMRT (87 % versus 48 %, p = 0.015). The local progression-free survival rate was also higher in patients who received IGRT (85 % versus 58 %, p = 0.006). More patients in the IGRT group completed the package of overall treatment time in ≤ 13 weeks and completed their course of radiation therapy in ≤ 8 weeks than patients in the IMRT group (89 % versus 68 %, p = 0.002; 84 % versus 58 %, p = 0.001), respectively. The rate of local failure in the primary tumor area was 24.0 % in the IMRT group and 6.8 % in the IGRT group. Among patients with primary local failure, the marginal failure rate was 52.6 % in the IMRT group and 0 % in the IGRT group.ConclusionsFor patients with locally advanced OCC, postoperative IGRT results in better overall survival, better local progression-free survival, less marginal failure and shorter overall treatment time than postoperative non-image-guided IMRT.

Highlights

We compared the outcome of patients who received non-image-guided intensity-modulated radiotherapy (IMRT) with those who received helical tomotherapy (HT), a daily image-guided radiotherapy (IGRT), after surgery for oral cavity cancer (OCC)
Helical tomotherapy (HT) is an IGRT system comprising megavoltage computed tomography (MVCT) that provides precise delivery of photons to a specific target region, thereby sparing critical organs from exposure to radiation and reducing the toxic effects associated with radiation therapy [3, 9,10,11]
We found that significantly more patients in the HT group completed the package of overall treatment time in ≤ 13 weeks and completed their course of radiation therapy in ≤ 8 weeks than patients in the IMRT group (POTT, 84 % vs 58 % (p = 0.001); overall treatment time of radiation therapy (OTTRT), 89 % vs 68 %, (p = 0.002))

Summary

Introduction

We compared the outcome of patients who received non-image-guided intensity-modulated radiotherapy (IMRT) with those who received helical tomotherapy (HT), a daily image-guided radiotherapy (IGRT), after surgery for oral cavity cancer (OCC). Intensity-modulated radiation therapy (IMRT) is safe and efficacious in the adjuvant setting for oral cavity cancer (OCC) [1,2,3,4]. IMRT provides better normal tissue protection by producing highly conformal doses of radiation to targets and sharp dose gradients between targets and. In this study we compared the clinical outcome of patients who received non-image-guided IMRT with those who received daily IGRT after surgery for oral cavity cancer

Methods

Results

Conclusion