title: Use of a conventional low neck field (LNF) and intensity-modulated radiotherapy (IMRT): no clinical detriment of IMRT to an anterior LNF during the treatment of head-and neck-cancer.
abstract: OBJECTIVE
  To determine differences in clinical outcomes using intensity-modulated radiotherapy (IMRT) or a standard low neck field (LNF) to treat low neck.
  
  
  METHODS
  This is a retrospective, single-institution study. Ninety-one patients with squamous cell carcinoma of the head and neck were treated with curative intent. According to physician preference, some patients were treated with LNF (Planning Target Volume 3) field using a single anterior photon field matched to the IMRT field. Field junctions were not feathered. The endpoints were time to failure and use of a percutaneous endoscopic gastrostomy (PEG) tube (as a surrogate of laryngeal edema causing aspiration), and analysis was done with χ(2) and log-rank tests.
  
  
  RESULTS
  Median follow-up was 21 months (range, 2-89 months). Median age was 60 years. Thirty-seven patients (41%) were treated with LNF, 84% were Stage III or IV. A PEG tube was required in 30%, as opposed to 33% without the use of LNF. Node 2 or 3 neck disease was treated more commonly without LNF (38% vs. 24%, p = 0.009). Failures occurred in 12 patients (13%). Only 1 patient treated with LNF failed regionally, 4.5 cm above the match line. The 3-year disease-free survival rate was 87% and 79% with LNF and without LNF, respectively (p = 0.2), and the 3-year LR failure rate was 4% and 21%, respectively (p = 0.04).
  
  
  CONCLUSIONS
  Using LNF to treat the low neck did not increase the risk of regional failure "in early T and early N diseases" or decrease PEG tube requirements.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Aruna
authors.initials: A
authors.lastname: Turaka
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.forename: Nicos
authors.initials: N
authors.lastname: Nicolaou
authors.forename: Miriam N
authors.initials: MN
authors.lastname: Lango
authors.forename: Barbara
authors.initials: B
authors.lastname: Burtness
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
authors.forename: John A
authors.initials: JA
authors.lastname: Ridge
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Feigenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000295:instrumentation / Q000706:statistics & numerical data; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D016014:Linear Models; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000970:Antineoplastic Agents
references.citation: Int J Radiat Oncol Biol Phys. 2002 Sep 1;54(1):278-89
references.pmid: 12183002
references.citation: Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1000-5
references.pmid: 15978743
references.citation: Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):959-72
references.pmid: 15465215
references.citation: Head Neck. 2004 Mar;26(3):257-63; discussion 263-4
references.pmid: 14999801
references.citation: Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1299-309
references.pmid: 17241750
references.citation: Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):660-5
references.pmid: 18037580
references.citation: Int J Radiat Oncol Biol Phys. 2003 Feb 1;55(2):312-21
references.pmid: 12527043
references.citation: Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):49-60
references.pmid: 12909215
references.citation: Am J Clin Oncol. 2010 Dec;33(6):599-603
references.pmid: 21063195
references.citation: Int J Radiat Oncol Biol Phys. 1999 Aug 1;45(1):21-32
references.pmid: 10477002
references.citation: Radiother Oncol. 1998 Dec;49(3):273-8
references.pmid: 10075260
references.citation: Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S46-8
references.pmid: 17848293
references.citation: Med Dosim. 2005 Fall;30(3):135-8
references.pmid: 16112462
references.citation: Med Phys. 1999 Nov;26(11):2379-84
references.pmid: 10587220
references.citation: Int J Radiat Oncol Biol Phys. 2008 Jun 1;71(2):377-85
references.pmid: 18164838
references.citation: Int J Radiat Oncol Biol Phys. 2004 May 1;59(1):28-42
references.pmid: 15093896
references.citation: Med Phys. 2002 Jan;29(1):38-44
references.pmid: 11831571
references.citation: World J Surg. 2003 Jul;27(7):832-7
references.pmid: 14509515
references.citation: Phys Med Biol. 2000 Jul;45(7):1731-40
references.pmid: 10943915