title: Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma - a European singleinstitution analysis.
abstract: OBJECTIVE
  To analyse survival and toxicity outcomes in patients treated with primary intensity-modulated radiotherapy (IMRT) for oropharyngeal squamous cell carcinoma (OPSCC) in the era of routine human papilloma virus (HPV) testing.
  
  
  METHODS
  Single-institution case series.
  
  
  METHODS
  Tertiary Head and Neck Cancer Unit.
  
  
  METHODS
  A total of 186 patients received IMRT (+/- chemotherapy) for radical primary treatment of OPSCC between March 2010 and December 2013. HPV status was available for 88% of cases. Median radiation dose was 65 Gy in 30 daily fractions. 90% of stage III/IV patients received concurrent chemotherapy or cetuximab.
  
  
  METHODS
  Overall, disease-free and disease-specific survival; rates of late xerostomia and dysphagia.
  
  
  RESULTS
  A total of 177 patients completed treatment (Stage I/II: 23; Stage III/IV: 154), with median follow-up of 26 months. Estimated 3-year overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS) rates were 77.2% (70.5-83.9), 72.3% (65.4-79.2) and 80.2% (74.1-86.3). Estimated 3-year OS, DFS and DSS for HPV-positive patients were 90.9% (85.2-96.6), 87.9% (81.4-94.4) and 91.8% (86.3-97.3). A previously identified risk stratification method was validated, showing improved OS for low-risk over high-risk patients (HR 0.09, P < 0.001). The 2-year feeding tube retention rate was 6%, and 2-year grade ≥2 xerostomia rate was 38% (23% if mean contralateral parotid dose <24 Gy).
  
  
  CONCLUSIONS
  Outcomes with IMRT are favourable, particularly in the HPV-positive patient group. This data further supports the use of a previously described prognostication model that can be used to select patients for escalation/de-escalation clinical trials.
authors.affiliation: Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Bird
authors.affiliation: Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: De Felice
authors.affiliation: Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Michaelidou
authors.affiliation: Department of Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Thavaraj
authors.affiliation: Department of Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: J-P
authors.initials: JP
authors.lastname: Jeannon
authors.affiliation: Department of Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Lyons
authors.affiliation: Department of Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Oakley
authors.affiliation: Department of Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Simo
authors.affiliation: Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lei
authors.affiliation: Department of Clinical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Guerrero Urbano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D014987:Xerostomia / Q000453:epidemiology*