title: Impact of postoperative daily image-guided intensity-modulated radiotherapy on overall and local progression-free survival in patients with oral cavity cancer.
abstract: BACKGROUND
  We compared the outcome of patients who received non-image-guided intensity-modulated radiotherapy (IMRT) with those who received helical tomotherapy (HT), a daily image-guided radiotherapy (IGRT), after surgery for oral cavity cancer (OCC).
  
  
  METHODS
  During the period November 2006 to December 2013, a total of 152 postoperative OCC patients underwent either IMRT (n = 79) or daily IGRT (n = 73) 4 to 6 weeks after surgery. Patients in the IMRT group received 6 MV photon beams to 7 fields and those in the IGRT group received daily fractions of 1.8 or 2 Gy on five consecutive days.
  
  
  RESULTS
  Patients who received daily IGRT had higher 5-year overall survival than those who received IMRT (87% versus 48%, p = 0.015). The local progression-free survival rate was also higher in patients who received IGRT (85% versus 58%, p = 0.006). More patients in the IGRT group completed the package of overall treatment time in ≤ 13 weeks and completed their course of radiation therapy in ≤ 8 weeks than patients in the IMRT group (89% versus 68%, p = 0.002; 84% versus 58%, p = 0.001), respectively. The rate of local failure in the primary tumor area was 24.0 % in the IMRT group and 6.8% in the IGRT group. Among patients with primary local failure, the marginal failure rate was 52.6% in the IMRT group and 0 % in the IGRT group.
  
  
  CONCLUSIONS
  For patients with locally advanced OCC, postoperative IGRT results in better overall survival, better local progression-free survival, less marginal failure and shorter overall treatment time than postoperative non-image-guided IMRT.
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan. chenciab@gmail.com.|Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. chenciab@gmail.com.|Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. chenciab@gmail.com.
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Hsieh
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.|Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan.|Oriental Institute of Technology, New Taipei City, Taiwan.
authors.forename: Pei-Wei
authors.initials: PW
authors.lastname: Shueng
authors.affiliation: School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.|Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Li-Ying
authors.initials: LY
authors.lastname: Wang
authors.affiliation: Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.|School of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Yu-Chuen
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Liao
authors.affiliation: Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Wu-Chia
authors.initials: WC
authors.lastname: Lo
authors.affiliation: Division of Medical Oncology and Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Yu-Chin
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
authors.forename: Le-Jung
authors.initials: LJ
authors.lastname: Wu
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Tien
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011184:Postoperative Period; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome