Two-field versus three-field irradiation technique in the postoperative treatment of head-and-neck cancer.
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.
Yom
Sue S
SS
Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Morrison
William H
WH
Ang
K Kian
KK
Rosenthal
David I
DI
Perkins
George H
GH
Wong
Pei-Fong
PF
Garden
Adam S
AS
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