Outcome and patterns of failure after postoperative intensity modulated radiotherapy for locally advanced or high-risk oral cavity squamous cell carcinoma

Andreas Geretschläger,Pirus Ghadjar,Beat Bojaxhiu,Peter Manser,Susanne Crowe,Wock Hallermann,Daniel M Aebersold,Andreas Arnold

doi:10.1186/1748-717x-7-175

Abstract

BackgroundTo determine the outcome and patterns of failure in oral cavity cancer (OCC) patients after postoperative intensity modulated radiotherapy (IMRT) with concomitant systemic therapy.MethodsAll patients with locally advanced (AJCC stage III/IV) or high-risk OCC (AJCC stage II) who underwent postoperative IMRT at our institution between December 2006 and July 2010 were retrospectively analyzed. The primary endpoint was locoregional recurrence-free survival (LRRFS). Secondary endpoints included distant metastasis-free survival (DMFS), overall survival (OS), acute and late toxicities.ResultsOverall 53 patients were analyzed. Twenty-three patients (43%) underwent concomitant chemotherapy with cisplatin, two patients with carboplatin (4%) and four patients were treated with the monoclonal antibody cetuximab (8%).At a median follow-up of 2.3 (range, 1.1–4.6) years the 3-year LRRFS, DMFS and OS estimates were 79%, 90%, and 73% respectively. Twelve patients experienced a locoregional recurrence. Eight patients, 5 of which had both a flap reconstruction and extracapsular extension (ECE), showed an unusual multifocal pattern of recurrence. Ten locoregional recurrences occurred marginally or outside of the high-risk target volumes. Acute toxicity grades of 2 (27%) and 3 (66%) and late toxicity grades of 2 (34%) and 3 (11%) were observed.ConclusionLRRFS after postoperative IMRT is satisfying and toxicity is acceptable. The majority of locoregional recurrences occurred marginally or outside of the high-risk target volumes. Improvement of high-risk target volume definition especially in patients with flap reconstruction and ECE might transfer into better locoregional control.

Highlights

To determine the outcome and patterns of failure in oral cavity cancer (OCC) patients after postoperative intensity modulated radiotherapy (IMRT) with concomitant systemic therapy
Patient selection We retrospectively identified all patients with newly diagnosed OCC with either locally advanced disease (American Joint Committee on Cancer (AJCC) stage III or IV) or early stage high-risk disease (positive or close margins (< 3mm); perineural invasion; lymphovascular space invasion and synchronous primary tumors) who underwent postoperative IMRT between December 2006 and July 2010 at our Department of Radiation Oncology, Inselspital, Bern University Hospital
extracapsular extension (ECE) was detected in 11 flap reconstruction cases

Summary

Introduction

To determine the outcome and patterns of failure in oral cavity cancer (OCC) patients after postoperative intensity modulated radiotherapy (IMRT) with concomitant systemic therapy. Treatment of locally advanced or high-risk oral cavity cancer (OCC) involves extensive surgical procedures, often combined with flap reconstruction, followed by postoperative radiotherapy (RT) with systemic therapy if certain risk factors are present. In 2006/2007 we reevaluated our institutional policy for IMRT treatment of OCC patients. Having started IMRT treatments in 2002, we could draw upon own experience and patient results as well as a small number of publications [7,8,9,10,11,12,13]. We have retrospectively analyzed the outcome and patterns of failure of patients at our center having been treated

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