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Comparative Study
. 2016 Feb 23:16:139.
doi: 10.1186/s12885-016-2165-9.

Impact of postoperative daily image-guided intensity-modulated radiotherapy on overall and local progression-free survival in patients with oral cavity cancer

Chen-Hsi Hsieh  1   2   3 , Pei-Wei Shueng  4   5   6 , Li-Ying Wang  7   8 , Yu-Chuen Huang  9   10 , Li-Jen Liao  11 , Wu-Chia Lo  11 , Yu-Chin Lin  12 , Le-Jung Wu  4 , Hui-Ju Tien  4
Affiliations
Comparative Study

Impact of postoperative daily image-guided intensity-modulated radiotherapy on overall and local progression-free survival in patients with oral cavity cancer

Chen-Hsi Hsieh et al. BMC Cancer. .

Abstract

Background: We compared the outcome of patients who received non-image-guided intensity-modulated radiotherapy (IMRT) with those who received helical tomotherapy (HT), a daily image-guided radiotherapy (IGRT), after surgery for oral cavity cancer (OCC).

Methods: During the period November 2006 to December 2013, a total of 152 postoperative OCC patients underwent either IMRT (n = 79) or daily IGRT (n = 73) 4 to 6 weeks after surgery. Patients in the IMRT group received 6 MV photon beams to 7 fields and those in the IGRT group received daily fractions of 1.8 or 2 Gy on five consecutive days.

Results: Patients who received daily IGRT had higher 5-year overall survival than those who received IMRT (87% versus 48%, p = 0.015). The local progression-free survival rate was also higher in patients who received IGRT (85% versus 58%, p = 0.006). More patients in the IGRT group completed the package of overall treatment time in ≤ 13 weeks and completed their course of radiation therapy in ≤ 8 weeks than patients in the IMRT group (89% versus 68%, p = 0.002; 84% versus 58%, p = 0.001), respectively. The rate of local failure in the primary tumor area was 24.0 % in the IMRT group and 6.8% in the IGRT group. Among patients with primary local failure, the marginal failure rate was 52.6% in the IMRT group and 0 % in the IGRT group.

Conclusions: For patients with locally advanced OCC, postoperative IGRT results in better overall survival, better local progression-free survival, less marginal failure and shorter overall treatment time than postoperative non-image-guided IMRT.

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Figures

Fig. 1
Fig. 1
The actuarial 5-year Kaplan–Meier survival estimates. a Overall survival curve; b Local progression-free survival curve for postoperative oral cavity cancer patients treated with intensity-modulated radiation therapy (IMRT) or helical tomotherapy (HT), with or without concurrent chemotherapy
Fig. 2
Fig. 2
The actuarial 5-year Kaplan–Meier curves for overall survival curve according to risk factors in patients with postoperative oral cavity cancer patients treated with intensity-modulated radiation therapy (IMRT) or helical tomotherapy (HT), with or without concurrent chemotherapy. a positive resection-margin; b positive extracapsular spread (ECE); c positive perineural invasion (PNI); d positive lymphovascular space involvement (LVSI); e two or more positive lymph nodes; f T3,4
Fig. 3
Fig. 3
The actuarial 5-year Kaplan–Meier estimates of local progression-free survival according to risk factors in postoperative oral cavity cancer patients treated with intensity-modulated radiation therapy (IMRT) or helical tomotherapy (HT), with or without concurrent chemotherapy. a positive resection-margin; b positive perineural invasion (PNI); c positive lymphovascular space involvement (LVSI); d two or more positive lymph nodes; e T3,4
Fig. 4
Fig. 4
a The actuarial 5-year Kaplan–Meier curves for overall survival in postoperative oral cavity cancer patients treated with radiotherapy with a package of overall treatment time (POTT) less than 13 weeks or more than 13 weeks; b The actuarial 5-year -year Kaplan–Meier estimates of local progression-free survival in postoperative oral cavity cancer patients treated with radiotherapy with an overall treatment time of radiation therapy (OTTRT) less than 8 weeks or longer than 8 weeks
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