title: Treatment of oral cavity squamous cell carcinoma with adjuvant or definitive intensity-modulated radiation therapy.
abstract: OBJECTIVE
  The optimal management of oral cavity squamous cell carcinoma (OCSCC) typically involves surgical resection followed by adjuvant radiotherapy or chemoradiotherapy (CRT) in the setting of adverse pathologic features. Intensity-modulated radiation therapy (IMRT) is frequently used to treat oral cavity cancers, but published IMRT outcomes specific to this disease site are sparse. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for OCSCC.
  
  
  METHODS
  Retrospective study of all patients treated at Dana-Farber Cancer Institute for OCSCC with adjuvant or definitive IMRT between August 2004 and December 2009. The American Joint Committee on Cancer disease stage criteria distribution of this cohort included 5 patients (12%) with stage I; 10 patients (24%) with stage II (n = 10, 24%); 14 patients (33%) with stage III (n = 14, 33%); and 13 patients (31%) with stage IV. The primary endpoint was overall survival (OS); secondary endpoints were locoregional control (LRC) and acute and chronic toxicity.
  
  
  RESULTS
  Forty-two patients with OCSCC were included, 30 of whom were initially treated with surgical resection. Twenty-three (77%) of 30 surgical patients treated with adjuvant IMRT also received concurrent chemotherapy, and 9 of 12 (75%) patients treated definitively without surgery were treated with CRT or induction chemotherapy and CRT. With a median follow-up of 2.1 years (interquartile range, 1.1-3.1 years) for all patients, the 2-year actuarial rates of OS and LRC following adjuvant IMRT were 85% and 91%, respectively, and the comparable results for definitive IMRT were 63% and 64% for OS and LRC, respectively. Only 1 patient developed symptomatic osteoradionecrosis, and among patients without evidence of disease, 35% experienced grade 2 to 3 late dysphagia, with only 1 patient who was continuously gastrostomy-dependent.
  
  
  CONCLUSIONS
  In this single-institution series, postoperative IMRT was associated with promising LRC, OS, and lower late toxicity rates, and chemoradiotherapy was a successful treatment for patients with high-risk disease. In contrast, outcomes of radiation-based treatment for patients with inoperable locally advanced disease were markedly less successful.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. dsher@lroc.harvard.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Sher
authors.forename: Vijaya
authors.initials: V
authors.lastname: Thotakura
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Balboni
authors.forename: Charles M
authors.initials: CM
authors.lastname: Norris
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Posner
authors.forename: Jochen
authors.initials: J
authors.lastname: Lorch
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Annino
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
mesh_terms: D001900:Boston; D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D059248:Chemoradiotherapy; D059186:Chemoradiotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis