Patterns of relapse following surgery and postoperative intensity modulated radiotherapy for oral and oropharyngeal cancer.
BACKGROUND
To investigate the patterns of relapse following intensity modulated radiotherapy (IMRT) given after radical surgery for oral and oropharyngeal squamous cell cancer.


METHODS
One hundred and two patients with oral or oropharyngeal cancer were treated with radical surgery followed by IMRT up to a mean total dose of 60 Gy between years 2001 and 2007. Thirty-nine of the patients (%) also received concomitant weekly cisplatin. Forty of the patients had oral and 62 had oropharyngeal cancer. Data on the tumour, patient and treatment factors were collected. Following therapy the patients were followed by clinical examination, endoscopy and MRI/CT at 2- to 3-months interval up to 2 years and thereafter at 6-month intervals.


RESULTS
The mean follow-up time of the patients was 55 months (range, 26-106 months). The rate for local tumour control for the whole cohort was 92.2%: 87.5% for oral cancer patients and 96.7% for oropharyngeal cancer patients. The 5-year disease specific survival was 90.2% and 5-year overall survival 84.3%. During the follow-up eight locoregional recurrences were observed, three at the primary tumour site and one at regional nodal site and four at both sites. The mean time to primary tumour recurrence was seven months (range, 2-10 months) and to nodal recurrence seven months (range, 2-12 months). Distant metastasis occurred in six (6%) patients. The factors associated with poor prognosis were the primary tumour size and tumour site with oral cancers having worse outcome. The treatment was well tolerated with no unexpected toxicities. The most frequent late toxicity was dysphagia necessitating permanent PEG in five patients. This was correlated with the advanced primary tumour size and resulting in wide tumour excision and reconstruction.


CONCLUSIONS
Surgery combined with postoperative radiotherapy given as IMRT results in low level of tumour recurrence.
Department of Oncology, Helsinki University Central Hospital, Finland.
Juhani
J
Collan
Marie
M
Lundberg
Leila
L
Vaalavirta
Leif
L
Bäck
Mikael
M
Kajanti
Antti
A
Mäkitie
Mikko
M
Tenhunen
Kauko
K
Saarilahti
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002945:Cisplatin / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D011859:Radiography; D050397:Radiotherapy, Intensity-Modulated; D012008:Recurrence; D013997:Time Factors
D000970:Antineoplastic Agents; D002945:Cisplatin