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Definitive radiotherapy for squamous cell carcinoma of the oral cavity: a single-institution experience

Kristin Lang
Kristin Lang
, 
Melissa Baur
Melissa Baur
, 
Thomas Held
Thomas Held
, 
Rami El Shafie
Rami El Shafie
, 
Julius Moratin
Julius Moratin
, 
Christian Freudlsperger
Christian Freudlsperger
, 
Karim Zaoui
Karim Zaoui
, 
Nina Bougatf
Nina Bougatf
, 
Jürgen Hoffmann
Jürgen Hoffmann
, 
Peter K. Plinkert
Peter K. Plinkert
, 
Jürgen Debus
Jürgen Debus
 y 
Sebastian Adeberg
Sebastian Adeberg
   | 19 nov 2021
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Article Category: Research Article
Publicado en línea: 19 nov 2021
Páginas: 467 - 473
Recibido: 13 may 2021
Aceptado: 21 sept 2021
DOI: https://doi.org/10.2478/raon-2021-0041
© 2021 Kristin Lang, Melissa Baur, Thomas Held, Rami El Shafie, Julius Moratin, Christian Freudlsperger, Karim Zaoui, Nina Bougatf, Jürgen Hoffmann, Peter K. Plinkert, Jürgen Debus, Sebastian Adeberg, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

The 5-year Kaplan-Meier estimates for overall survival (OS) with systemic treatment (blue) was 43.9% vs. 23.1% with radiotherapy alone (green) (p = 0.05, HR 2.1, 1.1–4.2).
The 5-year Kaplan-Meier estimates for overall survival (OS) with systemic treatment (blue) was 43.9% vs. 23.1% with radiotherapy alone (green) (p = 0.05, HR 2.1, 1.1–4.2).

Summary of the most important studies for definitive radiotherapy in patients with oral cavity cancer as an overview radiotherapy

Study Period Radiotherapy No. of patients CHT/IT LDFS PFS OS
Lin et al.18 1995–2007 42% IMRT 115 48% 27% (3yr) n/a 15%
CHT (3yr)
100% 79% 59% 63%
Foster et al.17 1994–2014 54% IMRT 140 CHT (5yr) (5yr) (5yr)
Studer et al.8 2002–2011 100% IMRT 54 68% n/a 37% 37%
CHT/IT (4yr) (4yr)
Pederson et al.9 2001–2004 100% IMRT 21 100% 76% 71% 76%
CHT (5yr) (5yr) (5yr)
Hosny et al.19 35% 42% 78% 50%
2005–2014 100% IMRT 21 CHT (5yr) (5yr) (5yr)
Present Study 2000–2019 74% IMRT 119 86.5% 61.9% 52.1% 47.2%
CHT/IT (5yr) (5yr) (5yr)

Overview about univariable cox regression analysis for overall survival (OS), progression free survival (PFS), local disease-free survival (LDFS), and metastasis free survival (MFS) in patients with oral squamous cell carcinoma (OSCC) undergoing definitive radiotherapy

Parameter OS PFS LDFS MFS
HR p-value HR p-value HR p-value HR p-value
(95% CI) (95% CI) (95% CI) (95% CI)
Age (< 60 years) 1.2 (0.6–2.2) 0.637 0.9 (0.4–1.7) 0.647 0.6 (0.3–1.3) 0.224 3.4 (0.7–16.8) 0.120
Sex male vs. female 1.2 (0.6–2.4) 0.570 0.9 (0.5–2.0) 0.950 1.1 (0.5–2.4) 0.881 1.3 (0.3–5.1) 0.741
T Tstage 1/2 vs. T3/4 2.1 (1.1–4.2) 0.036 1.3 (1.0–1.8) 0.077 1.4 (0.9–2.0) 0.072 2.1 (0.9–4.5) 0.071
N stage N0 vs. N+ 2.1 (1.1–4.2) 0.036 2.4 (1.1–5.3) 0.026 2.7 (1.1–6.3) 0.027 2.8 (0.8–5.4) 0.071
RT dose < 70.0 Gy vs. >/= 67.0 Gy 1.9 (1.0–3.8) 0.05 1.5 (0.7–3.1) 0.267 1.4 (0.6–3.1) 0.393 1.7 (0.4–7.0) 0.428
Concomitant therapies 2.1 (1.0–4.1) 0.05 1.2 (0.9–1.5) 0.227 1.5 (0.7–3.5) 0.294 0.4 (0.1–3.3) 0.409
Concomitant therapies CHT vs. IT 1.2 (0.9–1.5) 0.216 1.5 (0.7–3.3) 0.296 1.2 (0.6–2.7) 0.586 0.7 (0.2–2.7) 0.580
RT technique IMRT vs. 3D 0.6 (0.4–1.2) 0.183 0.7 (0.3–1.3) 0.258 0.7 (0.3–1.4) 0.282 1.2 (0.3–5.0) 0.765
Risk factor history 1.1 (0.8–1.4) 0.536 0.9 (0.7–1.3) 0.690 0.9 (0.6–1.1) 0.328 1.5 (0.7–3.0) 0.295

Early and late toxicity after radiotherapy

Early treatment toxicity (< 90 days) No of patients n (%) Late treatment toxicity (> 90 days) No of patients n (%)
CTCAE grade CTCAE grade
Mucositis
         1 6 (13.0)
         2 19 (39.7)
         3 17 (35.6)
         4 2 (3.4)
Dermatitis
         1 12 (24.7)
         2 15 (31.5)
         3 5 (11.0)
Xerostomia
         1 15 (30.8) 1 19 (39.7)
         2 4 (8.9) 2 17 (35.6)
         3 1 (2.1) 3 1 (2.1)
Dysphagia
         1 9 (19.2) 1 15 (30.8)
         2 17 (34.9) 2 5 (11.0)
         3 12 (24.0) 3 4 (8.9)
Loss of taste (late toxicity)
         29 (60.0)
Trismus (late toxicity)
         13 (26.0)
Osteoradionecrosis (late toxicity)
         4 (8.9)

RT treatment characteristics

Technique
         3D-CRT 17 (34.7%)
         IMRT 32 (65.3%)
RT-Dose
         Median total dose base plan (without boost) 57.5 Gy (range: 50.0–65.9 Gy)
         Median single dose base plan (without boost) 1.9 Gy (range: 1.7–2.1 Gy)
Boost
         Yes 45 (91.8%)
         SIB 38 (84.4%)
         Sequential 7 (15.6%)
         no 4 (8.2%)
         Median total dose boost plan 12.0 Gy (range: 8.0–20.0 Gy)
         Median single dose boost plan 2.2 Gy (range: 2.0–2.2 Gy)
         Cumulative total dose (base + boost plan) 70.0 Gy (range: 60.0–72.0 Gy)
RT-Volume
         CTV dimension base plan 829.6 ccm (range: 61.7–1554.4 ccm)
         CTV dimension boost plan 178.5 ccm (range: 31.4–535.8 ccm)

Patient characteristics

Characteristic Number of patients (percentage)
Gender
         Male 30 (61.2%)
         Female 19 (38.8%)
Age, years
         Median (range) 61 years (17–85 years)
T-stage
         T1 8 (16.3%)
         T2 12 (24.5%)
         T3 7 (14.3%)
         T4 22 (44.9%)
N-stage
         N0 20 (40.8%)
         N+ 29 (59.2%)
Grading
         1 5 (10.2%)
         2 10 (20.4%)
         3 34 (69.4%)
Risk factors
         Smoking history 29 (59.2%)
         Alcohol consumption 6 (12.2%)
         none 14 (28.6%)
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