title: Intensity-modulated radiotherapy in the treatment of oropharyngeal cancer: an update of the Memorial Sloan-Kettering Cancer Center experience.
abstract: OBJECTIVE
  To update the Memorial Sloan-Kettering Cancer Center's experience with intensity-modulated radiotherapy (IMRT) in the treatment of oropharyngeal cancer (OPC).
  
  
  METHODS
  Between September 1998 and April 2009, 442 patients with histologically confirmed OPC underwent IMRT at our center. There were 379 men and 63 women with a median age of 57 years (range, 27-91). The disease was Stage I in 2%, Stage II in 4%, Stage III in 21%, and Stage IV in 73% of patients. The primary tumor subsite was tonsil in 50%, base of tongue in 46%, pharyngeal wall in 3%, and soft palate in 2%. The median prescription dose to the planning target volume of the gross tumor was 70 Gy for definitive (n = 412) cases and 66 Gy for postoperative cases (n = 30). A total 404 patients (91%) received chemotherapy, including 389 (88%) who received concurrent chemotherapy, the majority of which was platinum-based.
  
  
  RESULTS
  Median follow-up among surviving patients was 36.8 months (range, 3-135). The 3-year cumulative incidence of local failure, regional failure, and distant metastasis was 5.4%, 5.6%, and 12.5%, respectively. The 3-year OS rate was 84.9%. The incidence of late dysphagia and late xerostomia ≥Grade 2 was 11% and 29%, respectively.
  
  
  CONCLUSIONS
  Our results confirm the feasibility of IMRT in achieving excellent locoregional control and low rates of xerostomia. According to our knowledge, this study is the largest report of patients treated with IMRT for OPC.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Setton
authors.forename: Nicola
authors.initials: N
authors.lastname: Caria
authors.forename: Jonathan
authors.initials: J
authors.lastname: Romanyshyn
authors.forename: Lawrence
authors.initials: L
authors.lastname: Koutcher
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Wolden
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.forename: Nicholas
authors.initials: N
authors.lastname: Rowan
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Sherman
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Fury
authors.forename: David G
authors.initials: DG
authors.lastname: Pfister
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Weiji
authors.initials: W
authors.lastname: Shi
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhang
authors.forename: Karen D
authors.initials: KD
authors.lastname: Schupak
authors.forename: Daphna Y
authors.initials: DY
authors.lastname: Gelblum
authors.forename: Shyam D
authors.initials: SD
authors.lastname: Rao
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002173:Cancer Care Facilities; D003680:Deglutition Disorders / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009519:New York City; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010157:Palatal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D010160:Palate, Soft; D010610:Pharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D014062:Tongue Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D014067:Tonsillar Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D017211:Treatment Failure; D014987:Xerostomia / Q000453:epidemiology