title: Marginal misses after postoperative intensity-modulated radiotherapy for head and neck cancer.
abstract: OBJECTIVE
  To describe the spatial distribution of local-regional recurrence (LRR) among patients treated postoperatively with intensity-modulated radiotherapy (IMRT) for head and neck cancer.
  
  
  METHODS
  The medical records of 90 consecutive patients treated by gross total resection and postoperative IMRT for squamous cell carcinoma of the head and neck from January 2003 to July 2009 were reviewed. Sites of disease were the oral cavity (43 patients), oropharynx (20 patients), larynx (15 patients), and hypopharynx (12 patients). Fifty patients (56%) received concurrent chemotherapy.
  
  
  RESULTS
  Seventeen of 90 patients treated with postoperative IMRT experienced LRR, yielding a 2-year estimate of local regional control of 80%. Among the LRR patients, 11 patients were classified as in-field recurrences, occurring within the physician-designated clinical target volume, and 6 patients were categorized as marginal recurrences. There were no out-of-field geographical misses. Sites of marginal LRRs included the contralateral neck adjacent to the spared parotid gland (3 patients), the dermal/subcutaneous surface (2 patients), and the retropharyngeal/retrostyloid lymph node region (1 patient).
  
  
  CONCLUSIONS
  Although the incidence of geographical misses was relatively low, the possibility of this phenomenon should be considered in the design of target volumes among patients treated by postoperative IMRT for head and neck cancer.
authors.affiliation: Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California 95817, USA. allen.chen@ucdmc.ucdavis.edu
authors.forename: Allen M
authors.initials: AM
authors.lastname: Chen
authors.forename: D Gregory
authors.initials: DG
authors.lastname: Farwell
authors.forename: Quang
authors.initials: Q
authors.lastname: Luu
authors.forename: Leon M
authors.initials: LM
authors.lastname: Chen
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Vijayakumar
authors.forename: James A
authors.initials: JA
authors.lastname: Purdy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D049268:Positron-Emission Tomography / Q000379:methods; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods