title: Clinical outcome and patterns of recurrence of head and neck squamous cell carcinoma with a limited field of postoperative radiotherapy.
abstract: BACKGROUND
  Postoperative radiotherapy is the standard treatment for head and neck squamous cell carcinoma having high-risk features in surgical specimens. However, its severe toxicity can be a significant problem. This study was undertaken to evaluate the efficacy of our limited-field postoperative radiotherapy with the aim of reducing morbidity by minimizing the radiation field.
  
  
  METHODS
  Between 2000 and 2009, 154 patients with head and neck squamous cell carcinoma received limited-field postoperative radiotherapy. The reason for postoperative radiotherapy was close/positive margins in 33 patients and extracapsular extension in 91. The median radiation dose was 50 Gy (30-66.4). The radiation field covered the tumor bed without lymph node regions for close/positive margins and only involved sites of the neck region were irradiated for multiple nodes or extracapsular extension.
  
  
  RESULTS
  With a median follow-up of 43 months for surviving patients, the 3-year overall survival and progression-free survival rates were 53.7 and 42.1%, respectively. The 3-year rates of progression-free survival of the group having major risks (i.e. close/positive margins and/or extracapsular extension) and the group with other risks were 34.7 and 62.8%, respectively (P < 0.01). Thirty-one local recurrences (20%), of which 22 were located out-of-field, and 44 regional recurrences (29%), of which 16 were located out-of-field, developed. Late toxicity of grade 3 or greater developed in only six patients (3.8%).
  
  
  CONCLUSIONS
  Although the toxicities associated with limited-field postoperative radiotherapy could be kept to lower levels, the locoregional control rate did not seem to be sufficient. We should arrange the radiation field depending on risk factors.
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Goto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Furutani
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tachibana
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.forename: Junji
authors.initials: J
authors.lastname: Ito
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hanai
authors.forename: Taijiro
authors.initials: T
authors.lastname: Ozawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirakawa
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016019:Survival Analysis
chemical_list: D009944:Organoplatinum Compounds; C053989:nedaplatin; D002945:Cisplatin; D005472:Fluorouracil
keywords: limited field; postoperative radiotherapy; squamous cell carcinoma of the head and neck