Pattern of failure after adjuvant postoperative radiotherapy in head and neck cancers
Keywords:
intensity-modulated radiotherapy, patterns of failure, postoperative radiotherapyAbstract
Background: Locoregional recurrence is a predominant failure in locally advanced head and neck cancers despite of multimodality treatment including surgery and adjuvant chemoradiation. Analysis of locoregional failure pattern can contribute to improvement of future treatment.
Objective: To evaluate pattern of failure in head and neck cancers treated with postoperative radiotherapy.
Materials and Methods: Head and neck cancer patients who underwent postoperative radiotherapy in Thammasat hospital from October 2015 to January 2019 were retrospectively reviewed. The site of locoregional recurrence were correlated with previous radiotherapy treatment plan.
Results: Total 49 patients of squamous cell carcinoma head and neck cancers underwent postoperative radiotherapy. Primary were originated from the following subsites; oral cavity 25(51%), oropharynx 1(2%), larynx 19(39%), hypopharynx 3(6%), unknown primary 1(2%). Pathological staging based on AJCC 7th edition were as followings: two were stage I (4%), two were stage II (4%), nine were stage III (18%),34 were stage IVA (69%), two were stage IVB(4%) and none were stage IVC. Pathological risk factors were as followings : nine positive margins(18%), 17 extracapsular extensions(35%),38 pathological T3 or pT4(78%), 18 pathological N2 or pN3(37%), 21 close margins(43%), nodal disease in level IV or V for primary oral cavity cancer in four patients(16%), 19 lymphovascular invasions(39%) and 18 perineural invasions(37%). Median follow up time was 16 months (range,2-48 months). There has been disease failure in 12 cases (25%) with eight locoregional failure (16.66%), six distant metastasis (12.5%) and two have synchronous locoregional and distant failure (4.16%). Median time of locoregional failure was 5.5 months (range, 3-26 months). Of eight locoregional failure, six were in-field, one was out-field and one had both in and out-field recurrence. The 2-year cumulative rate of overall survival, progression-free survival, distant metastasis-free survival and locoregional control rate were 64%, 53%, 84% and 74%, respectively.
Conclusion: In-field locoregional failure is the predominant pattern in head and neck cancers treated with adjuvant postoperative radiotherapy.
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