Ipsilateral Irradiation for Oral and Oropharyngeal Carcinoma Treated With Primary Surgery and Postoperative Radiotherapy

• Published in: International journal of radiation oncology, biology, physics Vol. 78; no. 3; pp. 682 - 688
• Main Authors: Vergeer, Marije R., M.D, Doornaert, Patricia A.H., M.D, Jonkman, Anja, M.D, Kaanders, Johannes H.A.M., M.D., Ph.D, van den Ende, Piet L.A., M.D, de Jong, Martin A., M.D, Leemans, C. Rene, M.D., Ph.D, Slotman, Ben J., M.D., Ph.D, Langendijk, Johannes A., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2010; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; BODY; Buccal mucosa; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; CARCINOMAS; Contralateral failure; DIGESTIVE SYSTEM; DISEASE INCIDENCE; DISEASES; Follow-Up Studies; HEAD; Head-and-neck cancer; Hematology, Oncology and Palliative Medicine; Humans; Incidence; Ipsilateral irradiation; LYMPH NODES; Lymph Nodes - pathology; Lymphatic Irradiation - methods; Lymphatic Metastasis; LYMPHATIC SYSTEM; Medical sciences; MEDICINE; METASTASES; Middle Aged; Mouth Neoplasms - mortality; Mouth Neoplasms - pathology; Mouth Neoplasms - radiotherapy; Mouth Neoplasms - surgery; NECK; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; NEOPLASMS; Netherlands; NUCLEAR MEDICINE; ORGANS; Oropharyngeal Neoplasms - mortality; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - radiotherapy; Oropharyngeal Neoplasms - surgery; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; PHARYNX; Postoperative radiotherapy; Radiation Injuries - epidemiology; Radiation Injuries - pathology; RADIOLOGY; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; RESPIRATORY SYSTEM; Salvage Therapy; SURGERY; THERAPY; Tongue Neoplasms - mortality; Tongue Neoplasms - pathology; Tongue Neoplasms - radiotherapy; Tongue Neoplasms - surgery; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Xerostomia - prevention & control; Netherlands; Postoperative radiotherapy; Head-and-neck cancer; Ipsilateral irradiation; Contralateral failure; Postoperative; Stomatology; Oropharynx; Malignant tumor; Radiotherapy; Ipsilateral; Treatment; Contralateral; Surgery; Oral cavity carcinoma; Irradiation; ENT disease; Head and neck cancer; Oral cavity disease; Failure; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.08.042

Purpose The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. Methods and Materials The study included 123 patients with well-lateralized squamous cell carcinomas treated with surgery and unilateral postoperative irradiation. Most patients had tumors of the gingiva (41%) or buccal mucosa (21%). The majority of patients underwent surgery of the ipsilateral neck ( n = 102 [83%]). The N classification was N0 in 73 cases (59%), N1 or N2a in 23 (19%), and N2b in 27 cases (22%). Results Contralateral metastases developed in 7 patients (6%). The 5-year actuarial CLNC was 92%. The number of lymph node metastases was the only significant prognostic factor with regard to CLNC. The 5-year CLNC was 99% in N0 cases, 88% in N1 or N2a cases, and 73% in N2b cases ( p = 0.008). Borderline significance ( p = 0.06) was found for extranodal spread. Successful salvage could be performed in 71% of patients with contralateral metastases. The prevalence of Grade 2 or higher xerostomia was 2.6% at 5 years. Conclusions Selected patients with oral or oropharyngeal carcinoma treated with primary surgery and postoperative ipsilateral radiotherapy have a very high CLNC with a high probability of successful salvage in case of contralateral metastases. However, bilateral irradiation should be applied in case of multiple lymph node metastases in the ipsilateral neck, particularly in the presence of extranodal spread. The incidence of radiation-induced morbidity is considerably lower as observed after bilateral irradiation.