title: Intensity-modulated radiotherapy for head-and-neck cancer in the community setting.
abstract: OBJECTIVE
  To review outcomes with intensity-modulated radiation therapy (IMRT) in the community setting for the treatment of nasopharyngeal and oropharyngeal cancer.
  
  
  METHODS
  Between April 2003 and April 2007, 69 patients with histologically confirmed cancer of the nasopharynx and oropharynx underwent IMRT in our practice. The primary sites included nasopharynx (11), base of tongue (18), and tonsil (40). The disease stage distribution was as follows: 2 Stage I, 11 Stage II, 16 Stage III, and 40 Stage IV. All were treated with a simultaneous integrated boost IMRT technique. The median prescribed doses were 70 Gy to the planning target volume, 59.4 Gy to the high-risk subclinical volume, and 54 Gy to the low-risk subclinical volume. Forty-five patients (65%) received concurrent chemotherapy. Toxicity was graded according to the Radiation Therapy Oncology Group toxicity criteria. Progression-free and overall survival rates were estimated with the Kaplan-Meier product-limit method.
  
  
  RESULTS
  Median duration of follow-up was 18 months. The estimated 2-year local control, regional control, distant control, and overall survival rates were 98%, 100%, 98%, and 90%, respectively. The most common acute toxicities were dermatitis (32 Grade 1, 32 Grade 2, 5 Grade 3), mucositis (8 Grade 1, 33 Grade 2, 28 Grade 3), and xerostomia (0 Grade 1, 29 Grade 2, 40 Grade 3).
  
  
  CONCLUSIONS
  Intensity-modulated radiotherapy in the community setting can be accomplished safely and effectively. Systematic internal review systems are recommended for quality control until sufficient experience develops.
authors.affiliation: Division of Radiation Oncology, The Oregon Clinic, Portland, OR 97213, USA. steven.seung@providence.org
authors.forename: Steven
authors.initials: S
authors.lastname: Seung
authors.forename: Joseph
authors.initials: J
authors.lastname: Bae
authors.forename: Matthew
authors.initials: M
authors.lastname: Solhjem
authors.forename: Stephen
authors.initials: S
authors.lastname: Bader
authors.forename: David
authors.initials: D
authors.lastname: Gannett
authors.forename: Eric K
authors.initials: EK
authors.lastname: Hansen
authors.forename: Jeannie
authors.initials: J
authors.lastname: Louie
authors.forename: Kelly
authors.initials: K
authors.lastname: Underhill
authors.forename: Christine
authors.initials: C
authors.lastname: Cha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D009922:Oregon; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy*; D011855:Radiodermatitis / Q000209:etiology*; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome