title: Intensity-modulated radiotherapy in the treatment of locoregionally advanced head and neck cancer: implementation and outcomes in a New Zealand community hospital.
abstract: Intensity-modulated radiotherapy (IMRT) has become the standard of care for squamous cell cancer of the head and neck (HNSCC). This report presents early outcomes of IMRT with concomitant chemotherapy in a community setting in New Zealand.
  
  
  
  Forty-eight patients with stage III and IV advanced HNSCC received definitive treatment with IMRT. A dose of 66 Gy in 30 fractions was delivered over 6 weeks with 3-weekly concurrent cisplatin after a single induction cycle of cisplatin and 5-fluorouracil. Acute toxicity, locoregional control (LRC), disease-free survival and overall survival (OS) outcomes were analysed.
  
  
  
  Follow-up ranged from 2 to 82 months (median 34 months). Acute grade 2 toxicity was observed in 27 patients and grade 3 toxicity in 19 patients. No patients experienced grade 4 toxicity and there were no treatment-related deaths. Locoregional failures occurred in six patients and distant metastatic disease occurred in five patients. Actuarial estimates of 3-year LRC, disease-free survival and OS were 87.3%, 74.4% and 73.7% respectively.
  
  
  
  Definitive treatment of stage III and IV cancer of the head and neck with IMRT and concurrent chemotherapy was achievable in the community setting. Acute toxicities were manageable and 3-year outcomes were comparable to other published series.
authors.affiliation: Department of Radiation Oncology Regional Cancer Treatment Service Palmerston North Hospital Roslyn Palmerston North New Zealand; Department of Radiation Oncology Wellington Blood and Cancer Centre Wellington Hospital Newtown Wellington New Zealand.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Rumley
authors.affiliation: Department of Radiation Oncology Regional Cancer Treatment Service Palmerston North Hospital Roslyn Palmerston North New Zealand.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Nedev
authors.affiliation: Department of Medicine Dunedin School of Medicine Dunedin Hospital Dunedin New Zealand.
authors.forename: Katrina
authors.initials: K
authors.lastname: Sharples
authors.affiliation: Department of Radiation Oncology Regional Cancer Treatment Service Palmerston North Hospital Roslyn Palmerston North New Zealand.
authors.forename: Jeat
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology Wellington Blood and Cancer Centre Wellington Hospital Newtown Wellington New Zealand.
authors.forename: David S
authors.initials: DS
authors.lastname: Lamb
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D050397:Radiotherapy, Intensity-Modulated; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin; D005472:Fluorouracil
keywords: Chemoradiotherapy; head and neck neoplasms; radiotherapy, intensity‐modulated; treatment outcome