title: Whole-Field Sequential Intensity-Modulated Radiotherapy for Local-Regional Advanced Head-and-Neck Squamous Cell Carcinoma.
abstract: OBJECTIVE
  There is little published data on the technique and results of whole-field (WF) sequential intensity-modulated radiotherapy (S-IMRT) for patients with head-and-neck squamous cell carcinoma (HNSCC). We report the treatment outcomes, adverse events (AEs), and dosimetric parameters in local-regional advanced (LRA) HNSCC patients treated with the WF S-IMRT technique.
  
  
  METHODS
  The IRB approved this retrospective study. Patients received WF S-IMRT with or without concomitant chemotherapy. Three separate IMRT plans corresponding to 3 planning target volumes were generated. This study reports patient and tumor characteristics, treatment-induced acute AEs based on CTCAE version 3.0, chronic AEs according to RTOG scale and treatment outcomes, local-regional control (LRC), distant metastases (DM), relapse-free survival (RFS), and overall survival (OS).
  
  
  RESULTS
  Between January 2003 and December 2010, 103 patients with LRA HNSCC were treated either definitively or postoperatively with WF S-IMRT, with (99 patients) or without (4 patients) concurrent chemotherapy. The median age was 55 years (range, 30 to 89 y). The median cumulative target dose was 70 Gy (range, 60 to 75 Gy). At a median follow-up of 40 months (range, 4 to 95 mo), the 2- and 5-year rates of OS were 94% and 77%, RFS were 90% and 84%, LRC were 97% and 93%, and DM were 9% and 11%, respectively. Grade 3 acute AEs included mucositis (68%), dysphagia (35%), weight loss (19.6%), and xerostomia (7.8%). Chronic worst grade 3 AEs included xerostomia (21.9%), weight loss (12.8%), and dysphagia (12.5%). Chronic grade 3 AEs at last follow-up included weight loss (6.25%), dysphagia (6.2%), and xerostomia (6.2%). No patient had an acute or chronic grade 4 AE, brachial plexopathy, or spinal cord injury.
  
  
  CONCLUSIONS
  WF S-IMRT results in excellent tumor control and an acceptable toxicity profile in LRA HNSCC patients treated with this technique.
authors.affiliation: Departments of *Radiation Oncology ‡Medicine, Division of Hematology/Oncology §Otolaryngology, Head and Neck Surgery ∥Preventive Medicine, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL †Department of Clinical Oncology, Alexandria University, Alexandria, Egypt.
authors.forename: Tamer
authors.initials: T
authors.lastname: Refaat
authors.forename: Mehee
authors.initials: M
authors.lastname: Choi
authors.forename: Tarita O
authors.initials: TO
authors.lastname: Thomas
authors.forename: Ian
authors.initials: I
authors.lastname: Bacchus
authors.forename: Mark
authors.initials: M
authors.lastname: Agulnik
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Pelzer
authors.forename: Ann L
authors.initials: AL
authors.lastname: Mellott
authors.forename: Alfred W
authors.initials: AW
authors.lastname: Rademaker
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Vythialinga
authors.initials: V
authors.lastname: Sathiaseelan
authors.forename: Bharat B
authors.initials: BB
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020516:Brachial Plexus Neuropathies / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D059186:Chemoradiotherapy, Adjuvant; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D052016:Mucositis / Q000209:etiology; D009303:Nasopharyngeal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D011832:Radiation Injuries / Q000209:etiology; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D000077195:Squamous Cell Carcinoma of Head and Neck; D016896:Treatment Outcome; D015431:Weight Loss; D014987:Xerostomia / Q000209:etiology