Outcomes of postoperative simultaneous modulated accelerated radiotherapy for head-and-neck squamous cell carcinoma.
OBJECTIVE
To evaluate the treatment efficacy and toxicity of postoperative simultaneous modulated accelerated radiotherapy (SMART) for patients with head-and-neck squamous cell carcinoma (HNSCC).


METHODS
Between February 2003 and September 2008, 51 patients with histologically confirmed HNSCC received postoperative intensity-modulated radiotherapy (N=33) or helical tomotherapy (N=18) using SMART after curative surgical resection. The sites included were the oral cavity (OC), oropharynx (OP), larynx, and hypopharynx in 23, 20, 5, and 3 patients, respectively.


RESULTS
The median follow-up duration of all patients and surviving patients were 32 (range, 5-78 months) and 39 months (range, 9-77 months), respectively. The 3-year overall survival, cause-specific survival, disease-free survival, locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) in all patients were 71%, 77%, 75%, 85%, and 82%, respectively. Although no significant difference in 3-year LRRFS were found between OC (82%) and OP (82%) carcinomas, the 3-year DMFS was worse in cases of OC (66%) carcinoma compared with OP carcinoma (95%; p=0.0414). Acute Grade 3 dermatitis, mucositis, and esophagitis occurred in 10%, 10%, and 2% of patients, respectively. At the last follow-up, Grade 3 xerostomia was documented in 10% of the patients. Young age (≤40 years) (p<0.001) and OC carcinoma primary (p=0.0142) were poor risk factors on univariate analysis for DMFS.


CONCLUSIONS
Postoperative SMART was observed to be effective and safe in patients with HNSCC.
Moon
Sung Ho
SH
Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Jung
Yuh-Seog
YS
Ryu
Jun Sun
JS
Choi
Sung Weon
SW
Park
Joo Yong
JY
Yun
Tak
T
Lee
Sang Hyun
SH
Cho
Kwan Ho
KH
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell; D018572:Disease-Free Survival; D004941:Esophagitis / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018307:Neoplasms, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011855:Radiodermatitis / Q000209:etiology / Q000473:pathology; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D000077195:Squamous Cell Carcinoma of Head and Neck; D047368:Tumor Burden; D014987:Xerostomia / Q000209:etiology; D055815:Young Adult