title: Development of Late Toxicities in Patients with Oral Tongue Cancer Treated with Surgical Resection and Adjuvant Radiation Therapy.
abstract: OBJECTIVE
  The late effects of RT are not well reported in patients with oral tongue cancer (OTC). This study reports the incidence of late effects and factors associated with the development of late effects in OTC patients.
  
  
  METHODS
  Patients with OTC treated in our institution from 2003 to 2013 were evaluated. The association between RT doses, including mandible maximum and minimum doses and total 3D maximum dose, and late toxicity, defined as development of osteoradionecrosis (ORN), percutaneous endoscopic gastrostomy (PEG) tube dependence for >6 months after treatment, and narcotic dependency >6 months posttreatment were assessed using both univariate and multivariable (MV) analysis.
  
  
  RESULTS
  Seventy-six patients with OTC (45% males and 55% females) were treated with definitive surgical resection followed by adjuvant RT. The median follow-up was 4.3 years. Combined late toxicities were reported in 38% of patients. Thirty-four percent of the patients had narcotic dependency and, 3.9% of the patients had ORN of the mandible. Thirteen percent of patients developed PEG tube dependency that was significantly associated with a higher 3D maximum radiation dose on univariate analysis (p< 0.01). On MV analysis, 3D maximum dose remained significantly associated with long-term PEG tube dependency (p= 0.05).
  
  
  CONCLUSIONS
  Patients with OTC treated with adjuvant RT are at significant risk for development of late toxicities. Increasing maximum dose is associated with long-term PEG tube dependence, and care should be taken to reduce the "hot spot" within radiation treatment plans as much as possible.
authors.affiliation: University of Vermont Medical Center , Burlington, VT , USA.
authors.forename: Mutlay
authors.initials: M
authors.lastname: Sayan
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cassidy
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, GA, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Switchenko
authors.affiliation: Department of Radiation Oncology, Emory University , Atlanta, GA , USA.
authors.forename: Oluwatosin A
authors.initials: OA
authors.lastname: Kayode
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Nabil F
authors.initials: NF
authors.lastname: Saba
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Conor E
authors.initials: CE
authors.lastname: Steuer
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.
authors.forename: Dong M
authors.initials: DM
authors.lastname: Shin
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA.
authors.forename: J Trad
authors.initials: JT
authors.lastname: Wadsworth
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA.
authors.forename: Mark
authors.initials: M
authors.lastname: El-Deiry
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA.
authors.forename: Mihir
authors.initials: M
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA; Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Beitler
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Higgins
keywords: PEG tube dependency; narcotic dependency; oral tongue cancer; osteoradionecrosis; radiation therapy