title: Two-field versus three-field irradiation technique in the postoperative treatment of head-and-neck cancer.
abstract: OBJECTIVE
  We have increasingly used a two-field noncoplanar "caudal tilt" technique (CTT) for irradiating postlaryngectomy and pharyngectomy patients to avoid matchline problems that can be encountered with the classic three-field head-and-neck radiation technique (3FT). This report compares the clinical outcomes of patients treated with postoperative radiation (PORT) using either 3FT or CTT.
  
  
  METHODS
  We conducted a retrospective review of the medical records of all patients with laryngeal or hypopharyngeal cancers consecutively treated with PORT between 1997 and 2002. Three-dimensional dosimetric planning was carried out for all patients.
  
  
  RESULTS
  Of 91 patients, 39 were treated with 3FT and 52 with CTT. The median follow-up was 34 months. Estimated rates of 2-year locoregional control, disease-free survival, and overall survival for patients treated with 3FT and CTT were, respectively, 92% and 85% (p=0.241), 62% and 55% (p=0.497), and 77% and 72% (p=0.616). There were no significant differences in the incidence of acute or late side effects in the two groups.
  
  
  CONCLUSIONS
  "Caudal tilt" technique is often used as an alternative to 3FT for postoperative radiotherapy in cases of greater medical and technical complexity. Despite its use in more challenging cases, CTT provides similar long-term clinical outcomes compared with standard 3FT, when computerized three-dimensional dosimetry is used to assure adequate dosimetry throughout the treated volume.
authors.affiliation: Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Sue S
authors.initials: SS
authors.lastname: Yom
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: K Kian
authors.initials: KK
authors.lastname: Ang
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: George H
authors.initials: GH
authors.lastname: Perkins
authors.forename: Pei-Fong
authors.initials: PF
authors.lastname: Wong
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011878:Radiotherapy / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome