title: Efficacy of intensity-modulated radiotherapy combined with chemotherapy or surgery in locally advanced squamous cell carcinoma of the head-and-neck.
abstract: OBJECTIVE
  Long-term locoregional control following intensity-modulated radiotherapy (IMRT) for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN) remains challenging. This study aimed to assess the efficacy and toxicity of IMRT with and without chemotherapy or surgery in locally advanced SCCHN.
  
  
  METHODS
  Between January 2007 and January 2011, 61 patients with locally advanced SCCHN were treated with curative IMRT in the Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University; 28% underwent definitive IMRT and 72% postoperative IMRT, combined with simultaneous cisplatin-based chemotherapy in 58%. The mean doses of definitive and postoperative IMRT were 70.8 Gy (range, 66-74 Gy). Outcomes were analyzed using Kaplan-Meier curves. Acute and late toxicities were graded according to Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer radiation morbidity scoring criteria.
  
  
  RESULTS
  At a median follow-up of 35 months, 3-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were 83.8%, 86.1%, 82.4%, 53.2%, and 62%, respectively. Postoperative IMRT (n = 44, 72%) had significantly higher LRFS/OS/DMFS than definitive IMRT (n = 17, 28%; P < 0.05). IMRT combined with chemotherapy (n = 35, 58%) had significantly higher LRFS/OS/DMFS than IMRT alone (n = 26, 42%; P < 0.05). One year after radiotherapy, the incidence of xerostomia of grade 1, 2, or 3 was 13.1%, 19.7%, and 1.6%, respectively. No grade 4 acute or late toxicity was observed.
  
  
  CONCLUSIONS
  IMRT combined with surgery or chemotherapy achieved excellent long-term locoregional control and OS in locally advanced SCCHN, with acceptable early toxicity and late side-effects.
authors.affiliation: Department of Radiotherapy Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China.
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.forename: Li-Qiong
authors.initials: LQ
authors.lastname: Diao
authors.forename: Mei
authors.initials: M
authors.lastname: Shi
authors.forename: Rui
authors.initials: R
authors.lastname: Ma
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Wang
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Xiao
authors.forename: Ying
authors.initials: Y
authors.lastname: Xue
authors.forename: Man
authors.initials: M
authors.lastname: Xu
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
keywords: IMRT; SCCHN; chemotherapy; prognosis analysis; surgery