Effect of Radiation Techniques in Treatment of Oropharynx Cancer

• Published in: The Laryngoscope 2008-04, Vol.118 (4), p.635-639
• Main Authors: Rusthoven, Kyle E., Raben, David, Ballonoff, Ari, Kane, Madeleine, Song, John I., Chen, Changhu
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - therapeutic use; Antineoplastic Agents, Phytogenic - therapeutic use; Biological and medical sciences; Carcinoma, Squamous Cell - radiotherapy; chemotherapy; combined-modality; Disease-Free Survival; Dose Fractionation; Enteral Nutrition; Female; Follow-Up Studies; Head and neck cancer; Humans; Male; Medical sciences; Mucositis - etiology; Neoadjuvant Therapy; Neoplasm Recurrence, Local - pathology; Oropharyngeal Neoplasms - radiotherapy; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; radiation techniques; radiation therapy; Radiotherapy, Conformal - methods; Radiotherapy, Intensity-Modulated - methods; Retrospective Studies; Skin - radiation effects; Survival Rate; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Xerostomia - etiology
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/MLG.0b013e31815fdf0e

Objectives: To compare the toxicity and outcomes of three radiotherapy techniques—three‐dimensional conformal (3D‐RT), accelerated fractionation with concomitant boost (AFxCB), and intensity modulated radiotherapy (IMRT)—in the combined modality treatment of stage III–IV squamous cell carcinoma (SCC) of the oropharynx. Study Design: Retrospective review. Methods: Between 1998 and 2007, a total of 87 patients were treated; 23 were treated with 3D‐RT, 32 with AFxCB, and 32 with IMRT. Systemic therapy consisted of platinum‐based chemotherapy in 81 and anti‐epidermal growth factor receptor (anti‐EGFR)‐targeted therapy in 6 cases. Median radiotherapy doses were 70Gy with 3D‐RT, 72Gy with AFxCB, and 69.3Gy with IMRT. Locoregional control, survival outcomes, and feeding tube (PEG) dependence were compared using log‐rank method. The incidence of acute mucositis and skin reaction, and grade ≥2 xerostomia at 6, 12, and 18 months after radiotherapy was compared using Fisher's exact test. Results: Median follow‐up was 24 months (range 3 to 103 months) for living patients. Two‐year overall survival (OS), disease‐free survival (DFS), and locoregional control (LRC) were 77.3%, 69.5%, and 86.4%, respectively. There was a trend toward improvement in LRC in patients treated with IMRT. Acute grade ≥3 skin and mucosal toxicity were significantly lower with IMRT compared to AFxCB (P < .001). Grade ≥2 xerostomia was significantly reduced with IMRT compared to AFxCB and 3D‐RT (P < .001). There was no difference in the actuarial rate of PEG dependence (P = .96). Conclusions: Compared to AFxCB and 3D‐RT, IMRT confers an improvement in toxicity and appears to have similar efficacy in patients with SCC of the oropharynx.