title: Treatment of oropharyngeal squamous cell carcinoma with IMRT: patterns of failure after concurrent chemoradiotherapy and sequential therapy.
abstract: BACKGROUND
  The optimal management of oropharyngeal squamous cell carcinoma (OPSCC) is controversial. Modern radiotherapy typically employs intensity-modulated radiation therapy (IMRT), and herein, we report the Dana-Farber Cancer Institute (DFCI) experience with IMRT-based treatment of OPSCC.
  
  
  METHODS
  Retrospective study of all patients treated at DFCI for OPSCC with definitive or adjuvant IMRT between 8/04 and 8/09. The primary end point was overall survival (OS); secondary end points were locoregional control (LRC) and freedom from distant metastases (FFDM). Propensity score matching was used to create concurrent chemoradiotherapy (CCRT) and sequential therapy (ST) cohorts equally balanced for patient and disease characteristics.
  
  
  RESULTS
  One hundred and sixty-three patients were included with 75% presenting with stage IV disease. Fifty-six patients (34%) were treated with ST. The three-year actuarial OS, LRC, and FFDM rates for the entire cohort/ST subset were 86%/89%, 86%/87%, and 88%/93%, respectively. There were no differences in OS, LRC, or FFDM between CCRT and ST in the propensity-matched cohort.
  
  
  CONCLUSIONS
  IMRT was associated with excellent OS, LRC, and FFDM. Although the results following ST were superb, there was no obvious benefit to ST after adjustment for selection bias. We recommend that ST be reserved for medically fit patients with a high risk of distant metastases.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston. Electronic address: dsher@lroc.harvard.edu.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sher
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medicine, Brigham and Women's Hospital, Boston.
authors.forename: V
authors.initials: V
authors.lastname: Thotakura
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston.
authors.forename: T A
authors.initials: TA
authors.lastname: Balboni
authors.affiliation: Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston.
authors.forename: C M
authors.initials: CM
authors.lastname: Norris
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medicine, Brigham and Women's Hospital, Boston.
authors.forename: R I
authors.initials: RI
authors.lastname: Haddad
authors.affiliation: Department of Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Posner
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Department of Medicine, Brigham and Women's Hospital, Boston.
authors.forename: J
authors.initials: J
authors.lastname: Lorch
authors.affiliation: Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston.
authors.forename: L A
authors.initials: LA
authors.lastname: Goguen
authors.affiliation: Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston.
authors.forename: D J
authors.initials: DJ
authors.lastname: Annino
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston.
authors.forename: R B
authors.initials: RB
authors.lastname: Tishler
mesh_terms: D000368:Aged; D000068196:Albumin-Bound Paclitaxel; D000418:Albumins / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy* / Q000821:virology; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D019008:Drug Resistance, Neoplasm; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D052162:Human papillomavirus 16; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000628:therapy* / Q000821:virology; D017239:Paclitaxel / Q000008:administration & dosage; D000077544:Panitumumab; D030361:Papillomavirus Infections / Q000150:complications* / Q000821:virology; D016016:Proportional Hazards Models; D011836:Radiation Tolerance; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D017211:Treatment Failure
chemical_list: D000068196:Albumin-Bound Paclitaxel; D000418:Albumins; D000911:Antibodies, Monoclonal; D043823:Taxoids; D000077143:Docetaxel; D000077544:Panitumumab; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil