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[3]
[70]
after surgery, OR: 2.89. Further work confirmed elevated but not OS (19.6% vs. 27.1%, P = 0.07).
RR 1.28 on LRC and decrease in OS (RR: 1.16) per month of
delay. The waiting list to start radiotherapy has negative effect On the technical aspects of PORT
on the prognosis according to a Dutch national study. [72] PORT administration is a particular challenge from the point
of view of the radiation oncologist. Anatomy distortion due
The accelerated repopulation during radiotherapy is a cause of to tumor resection, the presence of reconstruction flaps,
treatment failure, that can be increased by the undue prolongation prosthetic material and the position of scars may influence
of radiation therapy. González Ferreira et al. found an loss routes of dissemination and hamper assessing volumes at risk
[73]
[74]
in LRC of 1-1.2% per extra-day or 12-14% per extra-week. to irradiate. Due the narrow conformation of dose to the target
Prolongation of radiotherapy negatively interferes LRC and volume by IMRT, failure to design an adequate treatment volume
OS even in case of CRT. [74] will leave untreated areas of unrecognized risk; on the contrary
excessively large volumes lead to higher radiation exposure
Finally, the overall treatment time (OTT) from the day of of healthy tissue regions with consequent toxicity. [83,84] Close
surgery to the end of PORT showed prognostic significance collaboration between the radiation oncologist and head and
for the LRC and OS in a randomized trial when the entire neck surgeon is imperative when interpreting the pathological
duration of treatment was greater than 13 weeks. No other findings and surgical technique used; the engagement with
[75]
randomized studies have been published that would confirm this radiologist and pathologist will be necessary in most cases. There
finding, a retrospective series found no prognostic association in is currently no international consensus on standard volumes
the OTT with LRC neither OS. [76] for PORT irradiation in AHNC, but there are some guidelines
published. [85-88] .
Intensification of adjuvant treatment
The value of dose escalation with PORT as a function of risk of Adjuvant brachytherapy
recurrence has been explored in 2 prospective randomized In the specific case of OCSCC, PORT can be performed in fully or
[77]
trials. Peters and Withers showed the benefit of a dose partly by BT reaching an equivalent dose of 60-66 Gy (LDR or HDR)
of 63 Gy in 1.8 Gy fractions in patients with ECE, positive on the tumor bed when surgical margins are infiltrated (stages
or inadequate surgical margins. Ang et al. published the pT1-T3) EBRT is administered alone when cervical nodes are at
[75]
results of a multicenter trial that randomized 151 patients risk or primary surgical bed is not amenable for BT. Adjuvant BT
with high-risk criteria (ECE and 2 or more additional criteria) results are summarized in [Table 3]. [89-93] While in early-stage
between accelerated concomitant boost radiotherapy 63 Gy OCSCC treated with radical RT adding BT plays a critical role
in 5 weeks or the same dose in conventional fractionation in cure and local control, it is not the case of adjuvant setting
in 7 weeks. The accelerated treatment showed significantly (early nor advanced stage OCSCC) as either LRC and OS are
improvement in LRC and OS when the interval between equivalent between PORT-EBRT or PORT-BT. Table 4 shows
surgery and the start of PORT was not stretched or if the recent published studies on patients with advanced OCSCC
duration of the whole treatment (surgery plus PORT) no exceeded treated with PORT IMRT-based. [94-103]
13 weeks. Role of accelerated PORT is not firmly established, a
confirmatory phase III Dutch trial (POPART CKTO 2003-11) is Acknowledgments
currently in recruitment period.
The photographs illustrating in this article was kindly provided
A meta-analysis on the benefit of postoperative CRT confirmed by Dr. Enrique Miragall from Fundación ERESA [Figure 1] and
[78]
the reduction in RR of LRC (RR = 0.59) and death (RR = 0.80) Dr. José Luis Guinot from Instituto Valenciano de Oncología
and improvement in median survival (from 22-32 months to [Figure 2].
40-72 months). The authors state that the patients included in
those trials were under 70 years and with good performance Financial support and sponsorship
status, so the impact of the CRT in patients aged 70 or older Nil.
with associated co-morbidities is unknown. [50,78] A pooled
[79]
[80]
analysis of 2 phase III trials from RTOG and the European Conflicts of interest
Organization for Research and Treatment of Cancer (EORTC) There are no conflicts of interest.
[81]
on the role of the postoperative CRT in adjuvant treatment of
the SCCHN, confirmed that patients with ECE or ISMR were REFERENCES
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