Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

The University of California-San Francisco experience

Kim Huang, Ping Xia, Cynthia Chuang, Vivian Weinberg, Christine M. Glastonbury, David W Eisele, Nancy Y. Lee, Sue S. Yom, Theodore L. Phillips, Jeanne M. Quivey

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed. METHODS. Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high-risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low-risk CTV received 54 Gy in 1.64 Gy per fraction. RESULTS. With a median follow-up of 33 months, the 3-year local, regional, and locoregional progression-free probabilities were 94%, 94%, and 90%, respectively. The 3-year overall survival estimate was 83%. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow-up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible. CONCLUSIONS. Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects.

Original languageEnglish (US)
Pages (from-to)497-507
Number of pages11
JournalCancer
Volume113
Issue number3
DOIs
StatePublished - Aug 1 2008
Externally publishedYes

Fingerprint

San Francisco
Carcinoma
Intensity-Modulated Radiotherapy
Tumor Burden
Drug Therapy
Therapeutics
Osteoradionecrosis
Xerostomia
Gastrostomy
Parotid Gland
Platinum
Mandible
Survival

Keywords

  • Chemotherapy
  • Cisplatin
  • Head and neck cancer
  • Intensity-modulated radiotherapy
  • Locally advanced
  • Oropharyngeal carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma : The University of California-San Francisco experience. / Huang, Kim; Xia, Ping; Chuang, Cynthia; Weinberg, Vivian; Glastonbury, Christine M.; Eisele, David W; Lee, Nancy Y.; Yom, Sue S.; Phillips, Theodore L.; Quivey, Jeanne M.

In: Cancer, Vol. 113, No. 3, 01.08.2008, p. 497-507.

Research output: Contribution to journalArticle

Huang, K, Xia, P, Chuang, C, Weinberg, V, Glastonbury, CM, Eisele, DW, Lee, NY, Yom, SS, Phillips, TL & Quivey, JM 2008, 'Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma: The University of California-San Francisco experience', Cancer, vol. 113, no. 3, pp. 497-507. https://doi.org/10.1002/cncr.23578
Huang, Kim ; Xia, Ping ; Chuang, Cynthia ; Weinberg, Vivian ; Glastonbury, Christine M. ; Eisele, David W ; Lee, Nancy Y. ; Yom, Sue S. ; Phillips, Theodore L. ; Quivey, Jeanne M. / Intensity-modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma : The University of California-San Francisco experience. In: Cancer. 2008 ; Vol. 113, No. 3. pp. 497-507.
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abstract = "BACKGROUND. Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed. METHODS. Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high-risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low-risk CTV received 54 Gy in 1.64 Gy per fraction. RESULTS. With a median follow-up of 33 months, the 3-year local, regional, and locoregional progression-free probabilities were 94{\%}, 94{\%}, and 90{\%}, respectively. The 3-year overall survival estimate was 83{\%}. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow-up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible. CONCLUSIONS. Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects.",
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AU - Huang, Kim

AU - Xia, Ping

AU - Chuang, Cynthia

AU - Weinberg, Vivian

AU - Glastonbury, Christine M.

AU - Eisele, David W

AU - Lee, Nancy Y.

AU - Yom, Sue S.

AU - Phillips, Theodore L.

AU - Quivey, Jeanne M.

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N2 - BACKGROUND. Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed. METHODS. Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high-risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low-risk CTV received 54 Gy in 1.64 Gy per fraction. RESULTS. With a median follow-up of 33 months, the 3-year local, regional, and locoregional progression-free probabilities were 94%, 94%, and 90%, respectively. The 3-year overall survival estimate was 83%. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow-up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible. CONCLUSIONS. Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects.

AB - BACKGROUND. Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed. METHODS. Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high-risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low-risk CTV received 54 Gy in 1.64 Gy per fraction. RESULTS. With a median follow-up of 33 months, the 3-year local, regional, and locoregional progression-free probabilities were 94%, 94%, and 90%, respectively. The 3-year overall survival estimate was 83%. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow-up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible. CONCLUSIONS. Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects.

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KW - Head and neck cancer

KW - Intensity-modulated radiotherapy

KW - Locally advanced

KW - Oropharyngeal carcinoma

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