title: Intensity-modulated radiotherapy followed by a brachytherapy boost for oropharyngeal cancer.
abstract: BACKGROUND
  The purpose of this study was to reduce the incidence of radiation-induced toxicity in patients with early-stage oropharyngeal cancer, using highly conformal radiation techniques.
  
  
  METHODS
  Between 2000 and 2011, 167 patients with T1-3N0-3 oropharyngeal cancer were treated with 46-Gy intensity-modulated radiation therapy (IMRT) followed by 22-Gy brachytherapy boost. In patients with node-positive disease, neck dissection was performed.
  
  
  RESULTS
  The 5-year Kaplan-Meier estimates of local control, regional control, disease-free survival (DFS), and overall survival (OS) were 94%, 97%, 84%, and 72%, respectively. Feeding tubes were required in 26% of the patients. Grade ≥2 late xerostomia and dysphagia were 11% and 8%, respectively. Chemotherapy, tumor subsite, and bilateral neck irradiation correlate significantly with toxicity. Quality of life (QOL) scores deteriorate during and shortly after treatment but returned in all scales to baseline scores within 6 to 12 months, with the exception of xerostomia.
  
  
  CONCLUSIONS
  Brachytherapy boost and neck dissection (in node-positive oropharyngeal cancer) after 46-Gy of IMRT resulted in excellent outcomes with low incidence of late toxicity and good QOL scores.
authors.affiliation: Departments of Radiation Oncology, Erasmus Medical Center - Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.
authors.forename: Abrahim
authors.initials: A
authors.lastname: Al-Mamgani
authors.forename: Peter C
authors.initials: PC
authors.lastname: Levendag
authors.forename: Peter
authors.initials: P
authors.lastname: van Rooij
authors.forename: Cees A
authors.initials: CA
authors.lastname: Meeuwis
authors.forename: Aniel
authors.initials: A
authors.lastname: Sewnaik
authors.forename: David N
authors.initials: DN
authors.lastname: Teguh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D003680:Deglutition Disorders / Q000209:etiology; D003872:Dermatitis / Q000209:etiology; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D037981:Neck Dissection; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D014987:Xerostomia / Q000209:etiology
keywords: IMRT; brachytherapy; oropharyngeal cancer; quality of life; toxicity