title: Implementation of intensity-modulated radiotherapy for head and neck cancers in routine practice.
abstract: OBJECTIVE
  To report on patterns of relapse following implementation of intensity-modulated radiotherapy and subsequent changes in practice in a tertiary care centre.
  
  
  METHODS
  Between 2008 and 2011, 188 consecutive patients (mean age 59 years old) received intensity-modulated radiotherapies with curative intent for squamous cell carcinomas of the oral cavity (17.5%), oropharynx (43%), hypopharynx (21%), larynx (14%), sinonasal cavities (6%), nasopharynx (1.5%) at the university hospital of Besançon. There were stage I and II 9%, III 24.5%, IV 66.5%. One hundred and thirty-eight underwent exclusive intensity-modulated radiotherapy, 50 underwent postoperative intensity-modulated radiotherapy, 174 had concurrent chemotherapy, 57 had induction chemotherapy. Dynamic intensity-modulated radiotherapy with static fields was performed for all patients using sequential irradiation in 174 patients and simultaneous integrated boost irradiation in 14 patients.
  
  
  RESULTS
  With a median follow-up was 27.5 months, there was 79% of locoregional failures occurred in the 95% isodose. Two-year overall survival, disease-free, local failure-free and locoregional failure-free survival rates were73%, 60%, 79% and 72%, respectively. Prognostic factors for disease-free survival were stage (IV vs. I-III) with a relative risk of 1.7 [1.1-2.8] (P=0.02) and T stage with 1.6 [1.04-2.5] (P=0.03).
  
  
  CONCLUSIONS
  The current series showed similar patterns of failure as in other tertiary care centres. We did not identify intensity-modulated radiotherapy specific relapse risks.
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Bednarek
authors.affiliation: Department of radiotherapy, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
authors.forename: T V F
authors.initials: TV
authors.lastname: Nguyen
authors.affiliation: Clinical methodology center, CHU de Besançon, 2, place Saint-Jacques, 25030 Besançon, France.
authors.forename: M
authors.initials: M
authors.lastname: Puyraveau
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: É
authors.initials: É
authors.lastname: Bonnet
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: N
authors.initials: N
authors.lastname: Lescut
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Azélie
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: J
authors.initials: J
authors.lastname: Miny
authors.affiliation: Department of head and neck surgery, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: O
authors.initials: O
authors.lastname: Mauvais
authors.affiliation: Department of Oncology, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: T
authors.initials: T
authors.lastname: Maurina
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: F
authors.initials: F
authors.lastname: Tochet
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France; Université de Franche-Comté, 19, rue Ambroise-Paré, 25000 Besançon, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Bosset
authors.affiliation: Department of radiotherapy, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Department of radiotherapy, CHU de Besançon, 2, boulevard Fleming, 25030 Besançon, France. Electronic address: sun.xushan@wanadoo.fr.
authors.forename: X S
authors.initials: XS
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005602:France / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000453:epidemiology; D011379:Prognosis; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D000970:Antineoplastic Agents
keywords: Carcinomes de la tête et du cou; Head and neck cancer; IMRT; Locoregional failures; Planification de traitement; RCMI; Treatment planning; Échecs locorégionaux