2001 年 13 巻 3 号 p. 139-143
Background: Surgical intervention and adjuvant radiotherapy (RT) are often needed in the treatment of patients with buccal cancer. Optimal clinical target volume (CTV) delineation is important in RT planning. The aim of this report was to study the loco-regional relapse patterns following postoperative adjuvant RT for buccal cancer as an aid in defining the CTV for buccal cancer.
Patients and Methods: From July 1994 through December 1999, 23 consecutive patients (23 men) with squamous cell carcinoma of the buccal mucosa were treated with complete courses of curative postoperative adjuvant RT. Three of them received surgery due to recurrent disease, and one of the three received neck dissection only since he had recurrence at the neck only. The median age at the initiation of RT was 45 years (range, 31 to 68 years). The operations at the primary sites included composite resections in 19 patients and wide excisions in three patients. Ipsilateral neck dissections were performed for 21 patients. Close or positive margins were noted in 11 patients, while the others had negative pathological margins. The RT strategy generally constituted two stages with shrinking fields. The doses were more than 63 Gy except in one patient (median, 64.8 Gy; range, 60.8-69 Gy). Eight patients received chemotherapy. The Kaplan-Meier method was used in the calculation of overall survival (OS) and local-regional relapse free survival (LRRFS).
Results: After a median follow-up of 20 months (3-77 months), 13 patients had 17 local regional relapses (primary vs lymph node [LN] vs. primary+LN vs. metachronous carcinoma=5 vs. 4 vs. 3 vs. 1). The LN distribution were seven ipsilateral level Ib/II and one level VI LN failure. The 3-year/5-year LRRFS and OS were 40%/40% and 45%/34%, respectively.
Conclusions: Our retrospective analysis showed that most of the neck failures in patients with buccal cancer receiving postoperative adjuvant RT were at the ipsilateral level Ib/II LN. Thus, it might be appropriate to include only the ipsilateral level I, II, III LN and cheek in the CTV of postoperative adjuvant RT for buccal cancer.
