Single-Institute Clinical Experiences Using Whole-Field SimultaneousIntegrated Boost (SIB) Intensity-Modulated Radiotherapy (IMRT) and SequentialIMRT in Postoperative Patients With Oral Cavity Cancer (OCC)

摘要

This study aimed to review clinical experiences using whole-field simultaneousintegrated boost (SIB) intensity-modulated radiotherapy (IMRT) and sequentialIMRT in postoperative patients with oral cavity cancer (OCC). From November 2006to December 2014, a total of 182 postoperative patients with OCC who underwenteither SIB-IMRT (n = 63) or sequential IMRT (n = 119) were enrolledretrospectively and matched randomly according to multiple risk factors by acomputer. The differences were well balanced after patient matching(P = .38). The median follow-up time was 65 months. Forpatients treated with the SIB technique and the sequential technique, therespective mortality rates were 36.8% and 20.0% (P = .04). Theprimary recurrence rates were 26.3% and 10.0% (P = .02),respectively. The respective marginal failure rates were 26.7% and 16.7%. Amultivariate logistic regression analysis showed that patients who received theSIB technique had a 2.74 times higher risk of death than those who received thesequential technique (95% confidence interval = 1.10-6.79, P =.03). Sequential IMRT provided a significantly lower dose to the esophagus (5.2Gy, P = .02) and trachea (4.6 Gy, P = .03)than SIB-IMRT. For patients with locally advanced OCC, postoperative sequentialIMRT may overcome an unpredictable geographic miss, potentially with a lowermarginal failure rate in the primary area. Patients treated by sequential IMRTshow equal overall survival benefits to those treated by SIB-IMRT and a lowermortality rate than those treated by SIB-IMRT. Additionally, a reduced dose tothe esophagus and trachea compared to sequential IMRT was noted.