BackgroundOral cancer is very common in India. The reported 5-year survival of such patients is around 50% after treatment with surgery and radiotherapy, much lower than most of the developed countries.MethodsA retrospective study of a prospective database of oral cancer patients undergoing surgery from June 2009 to June 2013 was conducted. Follow-up details were updated from case records and by phone calls. Data were double entered in EpiData Entry version 3.1 and were analysed using EpiData Analysis software 2.1.0.73.ResultsTwo-hundred and twenty patients were analysed (136 males); 85% were consuming tobacco, mainly in chewable form. The majority (51.1%) had tongue cancer, of whom 75 patients (34.1%) had T4 tumours. Postoperative radiotherapy was given to 108 patients (49.1%). Forty had recurrence, of which 23 were in early stage. Of these, 19 showed node positivity (p < 0.01). Node-negative patients had 79% 5-year survival while node positive had 59% which is comparable to that reported in developed countries. Median disease-free survival duration was 48.2 months.ConclusionsNode positivity is the single factor affecting recurrence and survival. The overall survival and disease-free survival is better in patients without lymph node involvement and in patients with early stage of cancer as compared to the patients with node involvement and in advanced stages.
Purpose: To evaluate the feasibility of using volumetric modulated arc therapy (VMAT) using RapidArc to deliver total body irradiation (TBI) treatment. Methods: VMAT planning was performed a whole body computed tomography (CT) data set using Rapid Arc. The planning target volumes included entire body trimmed to 3 mm below the skin. The organs at risk included the lungs and kidneys. A dose of 12 Gy in 10 fractions was prescribed to the target volume. The VMAT-TBI technique consisted of three isocentres and three overlapping arcs: the head and neck, the chest, and the pelvis. The plans were prescribed to ensure, at a minimum, 95% planning target volume dose coverage with the prescription dose (percentage of volume receiving dose of 12 Gy was 95%) and maximum dose of 109.8%. Mean dose to lung was restricted at 8.6 Gy. Results: The total body volume in the study was 15469 cm 3 and the PTV volume was 11322 cm 3 . The mean dose to PTV was 104%. The homogeneity index was 0.09. Sparing of normal tissues with adequate coverage of skeletal bones was shown to be feasible with Rapid Arc. The study demonstrates that VMAT is feasible for TBI treatment. Unlike conventional TBI chest wall boost with electrons was not required. Conclusion: The technique for total body irradiation using RapidArc VMAT was found feasible and is undergoing further studies prior to clinical use.
Cite this article as: Chakraborty S, Patil VM, Babu S, Muttath G, Thiagarajan SK. Locoregional recurrences after post-operative volumetric modulated arc radiotherapy (VMAT) in oral cavity cancers in a resource constrained setting: experience and lessons learned. Br J Radiol 2015;88:20140795. FULL PAPER Locoregional recurrences after post-operative volumetric modulated arc radiotherapy (VMAT) in oral cavity cancers in a resource constrained setting: experience and lessons learned Results: 75 patients with a median follow-up of 24 months were analysed. 41 (55%) patients had oral tongue cancers and 52 (69%) of the patients had Stage IVA cancers. The 2-year locoregional recurrence-free survival, diseasefree survival and overall survival were 88.9%, 82.1% and 80.5%, respectively. With a median time to failure of 6.5 months, five infield and three outfield failures were identified. Conclusion: A relatively low rate of outfield failure and lack of marginal failure attests to the efficacy of VMAT in such patients. Modifications to our existing target delineation policy have been proposed. Advances in knowledge: The use of standardized target delineation methods allows safe use of VMAT IMRT even in resource-constrained settings.
Background:Concurrent chemoradiation is the treatment of choice for laryngeal-pharyngeal cancers. Apart from survival organ preservation remains major aims of the treatment. Advanced radiation techniques like VMAT have shown to reduce morbidity. The purpose of our study is to assess the late toxicities in patients treated with concurrent chemoradiation and its association with dose to organs at risk.Aims:Assessment of late toxicities following concurrent chemoradiation in patients with laryngopharyngeal cancers.Materials and Methods:Retrospective study at a tertiary cancer centre on patients with laryngeal and pharyngeal cancers treated with concurrent chemoradiation with VMAT upto a total dose of 69.3 -70 Gy in 33-35 fractions and concurrent chemotherapy with Cisplatin was done. Severe late toxicities and its association with demographic and clinical parameters and dose to OAR were studied. Data was analysed using EpiData analysis v2.2.2.182.Results:Of the 93 patients studied majority were males above 55 years. Oropharynx was the commonest site (58%) with T3 and N2 in majority. Late dysphagia and odynophagia was seen in 18(21%) and 23(27%) patients respectively. 16 (17%) had tube dependence and nine (9.6%) had aspiration pneumonia. D60, V50 and V60 along with site, node positivity and weight loss were found to be significantly associated with severe late toxicity.Conclusion:Oropharyngeal cancers, node positivity and weight loss were found to have significant grade III and above toxicities including tube dependency. Dose to larynx showed association with severe late toxicities, though dose to constrictors could not.
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