title: Patterns of disease recurrence following treatment of oropharyngeal cancer with intensity modulated radiation therapy.
abstract: OBJECTIVE
  To report mature results of a large cohort of patients diagnosed with squamous cell carcinoma of the oropharynx who were treated with intensity modulated radiation therapy (IMRT).
  
  
  METHODS
  The database of patients irradiated at The University of Texas, M.D. Anderson Cancer Center was searched for patients diagnosed with oropharyngeal cancer and treated with IMRT between 2000 and 2007. A retrospective review of outcome data was performed.
  
  
  RESULTS
  The cohort consisted of 776 patients. One hundred fifty-nine patients (21%) were current smokers, 279 (36%) former smokers, and 337 (43%) never smokers. T and N categories and American Joint Committee on Cancer group stages were distributed as follows: T1/x, 288 (37%); T2, 288 (37%); T3, 113 (15%); T4, 87 (11%); N0, 88(12%); N1/x, 140 (18%); N2a, 101 (13%); N2b, 269 (35%); N2c, 122 (16%); and N3, 56 (7%); stage I, 18(2%); stage II, 40(5%); stage III, 150(19%); and stage IV, 568(74%). Seventy-one patients (10%) presented with nodes in level IV. Median follow-up was 54 months. The 5-year overall survival, locoregional control, and overall recurrence-free survival rates were 84%, 90%, and 82%, respectively. Primary site recurrence developed in 7% of patients, and neck recurrence with primary site control in 3%. We could only identify 12 patients (2%) who had locoregional recurrence outside the high-dose target volumes. Poorer survival rates were observed in current smokers, patients with larger primary (T) tumors and lower neck disease.
  
  
  CONCLUSIONS
  Patients with oropharyngeal cancer treated with IMRT have excellent disease control. Locoregional recurrence was uncommon, and most often occurred in the high dose volumes. Parotid sparing was accomplished in nearly all patients without compromising tumor coverage.
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. agarden@mdanderson.org
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: Lei
authors.initials: L
authors.lastname: Dong
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Erich M
authors.initials: EM
authors.lastname: Stugis
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: Glisson
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.forename: Gary B
authors.initials: GB
authors.lastname: Gunn
authors.forename: David L
authors.initials: DL
authors.lastname: Schwartz
authors.forename: Merill S
authors.initials: MS
authors.lastname: Kies
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: K Kian
authors.initials: KK
authors.lastname: Ang
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001933:Brain Stem; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods; D058958:Organs at Risk; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D010306:Parotid Gland; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000401:mortality; D013116:Spinal Cord; D013280:Stomatitis / Q000209:etiology; D015996:Survival Rate; D047368:Tumor Burden