title: Patterns of failure after postoperative intensity-modulated radiotherapy for locally advanced and recurrent head and neck cancer.
abstract: OBJECTIVE
  To evaluate the feasibility of postoperative intensity-modulated radiotherapy for head and neck cancer by investigating the patterns of failure after this therapy.
  
  
  METHODS
  A retrospective chart review was performed.
  
  
  RESULTS
  Between March 2006 and December 2013, 122 consecutive patients with head and neck squamous cell carcinoma were treated by surgery followed by postoperative intensity-modulated radiotherapy. In regard to the site of the primary tumor, 59 (48%) patients had cancer of the oral cavity, 31 (26%) patients had cancer of the hypopharynx, 14 (11%) patients had cancer of the oropharynx, 10 (8%) patients had cancer of the larynx and 8 (7%) patients had cancer of unknown primary. The median follow-up period of the surviving patients was 54 months (range, 25-115). Concurrent chemotherapy was administered in 76 patients (62%). The median prescribed radiation dose was 66 Gy. The 3-year overall survival, progression-free survival, distant metastasis free survival and loco-regional control rates were 59%, 48%, 52.4% and 71%, respectively. Of the 122 patients, 32 developed loco-regional recurrence as the initial recurrence, including in-field recurrence in 26 patients, marginal recurrence in five patients and out-field recurrence in seven patients. Of the five patients with marginal recurrence, four have had two or more surgeries before the intensity-modulated radiotherapy and three had oral cavity cancer. Severe adverse events were not frequent, occurring at a frequency of <5%, except for mucositis. No severe toxicities associated with the flap reconstruction were observed either.
  
  
  CONCLUSIONS
  Postoperative intensity-modulated radiotherapy appears to be effective and feasible for patients with head and neck squamous cell carcinoma.
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Department of Radiology, Saga University Faculty of Medicine, Saga.
authors: Mitsutoshi
authors: M
authors: Ooishi
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa amotegi@east.ncc.go.jp.
authors: Atsushi
authors: A
authors: Motegi
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.
authors: Mitsuhiko
authors: M
authors: Kawashima
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.
authors: Satoko
authors: S
authors: Arahira
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.
authors: Sadamoto
authors: S
authors: Zenda
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.
authors: Naoki
authors: N
authors: Nakamura
authors: Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.
authors: Takaki
authors: T
authors: Ariji
authors: Department of Radiology, Saga University Faculty of Medicine, Saga.
authors: Sunao
authors: S
authors: Tokumaru
authors: Divisions of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, Kashiwa.
authors: Minoru
authors: M
authors: Sakuraba
authors: Divisions of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa.
authors: Makoto
authors: M
authors: Tahara
authors: Divisions of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
authors: Ryuichi
authors: R
authors: Hayashi
authors: Divisions of Radiation Oncology, National Cancer Center Hospital East, Kashiwa Divisions of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa.
authors: Tetsuo
authors: T
authors: Akimoto
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003872:Dermatitis / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D011184:Postoperative Period; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014987:Xerostomia / Q000209:etiology
keywords: intensity-modulated radiotherapy; patterns of failure; postoperative radiotherapy