title: Recurrent oropharyngeal cancer after organ preserving treatment: pattern of failure and survival.
abstract: The objectives is to thoroughly analyze the pattern of failure and oncologic outcome in recurrent oropharyngeal cancer (OPC) after (chemo)radiotherapy and correlate the site of failure to the planned radiation dose. Between January 2010 and April 2014, 57 patients with recurrent OPC after (chemo)radiotherapy were analyzed. Endpoints were pattern of failure and overall survival (OS). Local (LF) and regional failure (RF) were classified as in-field [>50% within gross tumor volume (GTV)], marginal [<50% within GTV but >50% within clinical target volume (CTV)], or out-of-field (>50% outside CTV) recurrences. In the whole group, 70 recurrences were reported. Of the 31 LF, 29 (93.5%) were in-field and 2 (6.5%) were marginal. No out-field LF was reported. Of the 21 RF, 13 RF (62%) were in-field, 6 (28.5%) marginal, and 2 (9.5%) out-of-field recurrences. Forty-three percent of RF was developed in an electively treated neck level, and 2 of them were contralateral. OS at 2 years in recurrent HPV positive, compared to HPV-negative OPC, were 66 and 18%, respectively (p = 0.011). OS was also significantly better in patients that were salvage treatment which was possible (70 vs. 6%, p < 0.001). Median survival after distant failure was 3.6 months. The great majority of LFs were located within the GTV and 43% of RFs developed in an electively treated neck level. The currently used margins and dose recipe and the indication for bilateral nodal irradiation need to be reevaluated. OS was significantly better in recurrent HPV-positive OPC and in patients, where salvage treatment was possible.
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Ridder
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Z A R
authors.initials: ZAR
authors.lastname: Gouw
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sonke
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Navran
authors.affiliation: Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Jasperse
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Heukelom
authors.affiliation: Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: M E T
authors.initials: MET
authors.lastname: Tesselaar
authors.affiliation: Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: W M C
authors.initials: WMC
authors.lastname: Klop
authors.affiliation: Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: M W M
authors.initials: MWM
authors.lastname: van den Brekel
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. a.almamgani@nki.nl.
authors.forename: Abrahim
authors.initials: A
authors.lastname: Al-Mamgani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D016879:Salvage Therapy; D017211:Treatment Failure
keywords: (Chemo)radiation; HPV; Pattern of failure; Recurrent oropharyngeal cancer