Effect of radiation techniques in treatment of oropharynx cancer.
OBJECTIVE
To compare the toxicity and outcomes of three radiotherapy techniques-three-dimensional conformal (3D-RT), accelerated fractionation with concomitant boost (AFxCB), and intensity modulated radiotherapy (IMRT)-in the combined modality treatment of stage III-IV squamous cell carcinoma (SCC) of the oropharynx.


METHODS
Retrospective review.


METHODS
Between 1998 and 2007, a total of 87 patients were treated; 23 were treated with 3D-RT, 32 with AFxCB, and 32 with IMRT. Systemic therapy consisted of platinum-based chemotherapy in 81 and anti-epidermal growth factor receptor (anti-EGFR)-targeted therapy in 6 cases. Median radiotherapy doses were 70Gy with 3D-RT, 72Gy with AFxCB, and 69.3Gy with IMRT. Locoregional control, survival outcomes, and feeding tube (PEG) dependence were compared using log-rank method. The incidence of acute mucositis and skin reaction, and grade > or = 2 xerostomia at 6, 12, and 18 months after radiotherapy was compared using Fisher's exact test.


RESULTS
Median follow-up was 24 months (range 3 to 103 months) for living patients. Two-year overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were 77.3%, 69.5%, and 86.4%, respectively. There was a trend toward improvement in LRC in patients treated with IMRT. Acute grade > or = 3 skin and mucosal toxicity were significantly lower with IMRT compared to AFxCB (P < .001). Grade > or = 2 xerostomia was significantly reduced with IMRT compared to AFxCB and 3D-RT (P < .001). There was no difference in the actuarial rate of PEG dependence (P = .96).


CONCLUSIONS
Compared to AFxCB and 3D-RT, IMRT confers an improvement in toxicity and appears to have similar efficacy in patients with SCC of the oropharynx.
Rusthoven
Kyle E
KE
Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado 80045-0508, USA.
Raben
David
D
Ballonoff
Ari
A
Kane
Madeleine
M
Song
John I
JI
Chen
Changhu
C
D000970:Antineoplastic Agents / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D052016:Mucositis / Q000209:etiology; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D012867:Skin / Q000528:radiation effects; D015996:Survival Rate; D014987:Xerostomia / Q000209:etiology
D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic