Misses and near-misses after postoperative radiation therapy for head and neck cancer: Comparison of IMRT and non-IMRT techniques in the CT-simulation era.

Abstract

The purpose of this study was to compare the patterns of failure focusing on the distribution of local-regional recurrence among patients treated postoperatively with conventional radiotherapy (RT) and intensity-modulated radiotherapy (IMRT) for head and neck cancer. The records of 130 patients treated by surgery and postoperative radiation therapy for squamous cell carcinoma of the head and neck were reviewed. Seventy-eight patients (60%) were treated using conventional RT and 52 patients (40%) were treated using IMRT. The 3-year estimates of local-regional control were 70% and 73% among patients treated by conventional RT and IMRT, respectively (p = .33). Among the local-regional recurrences in the IMRT group, 9 were in-field recurrences occurring within the physician-designated clinical target volume (CTV), and 4 were marginal recurrences involving the contralateral neck adjacent to the spared parotid gland (3 patients) and the retropharyngeal/retrostyloid lymph node region (1 patient). Our study showed that conventional RT and IMRT result in similar rates of local-regional control. The implications for CTV design are discussed herein.