title: Recurrence patterns of locally advanced head and neck squamous cell carcinoma after 3D conformal (chemo)-radiotherapy.
abstract: BACKGROUND
  To establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volumes
  
  
  METHODS
  151 locally advanced HNSCC patients were treated between 2004-2005 using radical three-dimensional conformal radiotherapy. Patients with prior surgery to the primary tumour site were excluded. The sites of locoregional relapses were correlated with radiotherapy plans by the radiologist and a planning dosimetrist.
  
  
  RESULTS
  Median age was 59 years (range:34-89). 35 patients had stage III disease, 116 patients had stage IV A/B. 36 patients were treated with radiotherapy alone, 42 with induction chemotherapy, 63 with induction and concomitant chemoradiotherapy and 10 concomitant chemoradiotherapy. Median follow-up was 38 months (range 3-62). 3-year cause specific survival was 66.8%. 125 of 151 (82.8%) achieved a complete response to treatment. Amongst these 125 there were 20 local-regional recurrence, comprising 8 local, 5 regional and 7 simultaneous local and regional; synchronous distant metastases occurred in 7 of the 20. 9 patients developed distant metastases in the absence of locoregional failure. For the 14 local recurrences with planning data available, 12 were in-field, 1 was marginal, and 1 was out-of-field. Of the 11 regional failures with planning data available, 7 were in-field, 1 was marginal and 3 were out-of-field recurrences.
  
  
  CONCLUSIONS
  The majority of failures following non-surgical treatment for locally advanced HNSCC were loco-regional, within the radiotherapy target volume. Improving locoregional control remains a high priority.
authors: St James's Institute of Oncology, Leeds, UK. Mehmet.Sen@leedsth.nhs.uk
authors: Didem C
authors: DC
authors: Oksuz
authors: Robin J
authors: RJ
authors: Prestwich
authors: Brendan
authors: B
authors: Carey
authors: Stuart
authors: S
authors: Wilson
authors: Mustafa S
authors: MS
authors: Senocak
authors: Ananya
authors: A
authors: Choudhury
authors: Karen
authors: K
authors: Dyker
authors: Catherine
authors: C
authors: Coyle
authors: Mehmet
authors: M
authors: Sen
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