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Oropharynx 1Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Oropharyngeal Carcinoma
Oropharynx 2Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Carcinoma of oropharynx
•• WorkWork--up procedureup procedure
•• TNM stagingTNM staging
•• Primary treatmentPrimary treatment
•• FollowFollow--upup
•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease
•• ReferencesReferences
Oropharynx 3Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Clinical evaluation Evidence Option
l complete history of the diseasel weight and weight lossl performance status (Karnofsky / ECOG-WHO)l fiberoptic examination of H&N mucosal neck examinationl drawing of any lesions
Type CType CType CType CType CType C
Std.Std.Std.Std.Std.Std.
Oropharynx 4Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Endoscopic evaluation Evidence Option
l endoscopy under general anesthesia with biopsiesof any suspicious site
Type C Std.
Oropharynx 5Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Advanced clinical evaluation Evidence Option
l dental examination by oral surgeonl nutritional assessmentl others (if required)
Type CType CType C
Std.Std.Std.
Oropharynx 6Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Laboratory tests Evidence Option
l hemogram, coagulation tests, liver enzymes, kidney function (including a creatinine clearance)
l thyroid function: TSH (if radiotherapy scheduled)
Type C
Type C
Std.
Std.
Oropharynx 7Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Imaging Evidence Option
l Regional: CT scan (or MRI)1
l Metastatic work-up: chest X-ray, thoracic spiralCT scan
l Additional examination depending on previousfindings
l PET scan
Type CType C
Type C
Type 3
Std.Std.
Std.
Invest.1See guidelines for loco-regional imaging
Oropharynx 8Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Pathologic examination Evidence Option
Standards of the British Royal College ofPathologists (endorsed by EORTC)1
Type C Std.
1See pathology guidelines
Oropharynx 9Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Carcinoma of oropharynx
•• WorkWork--up procedureup procedure
•• TNM stagingTNM staging
•• Primary treatmentPrimary treatment
•• FollowFollow--upup
•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease
•• ReferencesReferences
Oropharynx 10Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Staging Evidence Option
• TNM classification (6th ed., 2002) • WHO International Classification of Diseases for
Oncology (ICD-O 9 or ICD-O 10)
Type C Type C
Std. Std.
For oropharynx and hypopharynx, T4 is divided into T4A (resectable) anT4B(unresectable) leading to the division of stage IV into stage IVA, stageIVB and stage IVC
Stage IVA T4aN0M0, T4aN1M0, T1N2M0, T2N2M0, T3N2M0, T4aN2MO
Stage IVB T4b any N M0, any T N3 M0
any T N3 M0
Stage IVC any T any N M1
Oropharynx 11Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
TNM/AJCC 1997 StagingTNM/AJCC 1997 Staging
• Tx: primary tumor cannot be assessed• T0: no evidence of primary tumor• T1: Tumor limited to one subsite of hypopharynx and ≤ 2 cm• T2: Tumor invades more than one subsites of
hypopharynx or an adjacent site, or > 2cm and ≤ 4 cm without fixation of hemilarynx
• T3: > 4 cm or with fixation of hemilarynx• T4a invades thyroid/cricoid cartilage, hyoid bone, thyroid gland,
esophagus or central compartment soft tissue*• T4b invades prevertebral fascia, encases carotid artery, or invades
mediastinal structures
* Includes prelaryngeal strap muscles and subcutaneous fat
Oropharynx 12Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
TNM/AJCC 1997 StagingTNM/AJCC 1997 Staging
• N0: no regional node metastasis• Nx: regional nodes cannot be assessed• N1: single ipsilateral node, ≤ 3 cm• N2a: single ipsilateral node, > 3 cm and ≤ 6 cm• N2b: multiple ipsilateral nodes, ≤ 6 cm• N2c: controlateral or bilateral nodes, ≤ 6 cm• N3: node > 6 cm
Oropharynx 13Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
TNM/AJCC 1997 StagingTNM/AJCC 1997 Staging
•• Mx: Distant Mx: Distant metastasismetastasis cannotcannot bebe assessedassessed•• M0: No distant M0: No distant metastasismetastasis•• M1: Distant M1: Distant metastasismetastasis
Oropharynx 14Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Carcinoma of oropharynx
•• WorkWork--up procedureup procedure
•• TNM stagingTNM staging
•• Primary treatmentPrimary treatment
•• FollowFollow--upup
•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease
•• ReferencesReferences
Oropharynx 15Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: base of tongue Evidence Option
l T1, N0, M0-RxTh (T+N bilateral)-RxTh (T+N bilateral) + brachyth (T)-surgery (T+N bilateral) ± RxTh1: young patient, infiltrative tumor, lateral tumor-bilateral ND ± RxTh (T±N)± brachyth (T)
l T1, N1,M0-RxTh (T+N bilateral)-surgery (T+N bilateral) ± RxTh1: young patient, infiltrative tumor, lateral tumor-bilateral ND ± RxTh (T±N) ± brachyth (T)
Type 3Type 3Type 3
Type 3
Type 3Type 3
Type 3
Std.Std.Std.
Std.
Std.Std.
Std.1 see guidelines for post-operative radiotherapy
Oropharynx 16Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: base of tongue Evidence Option
l T2, N0-N1, M0-"moderately advanced" RxTh protocol (T+N)1 ± ND2
-surgery (T+N bilateral) ± RxTh3: young patient, infiltrative tumor, lateral tumor
l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N)1 + ND2
-surgery (T) + bilateral ND + RxTh3
-unilateral (bilateral) ND + RxTh (T+N):e.g.T1-T2,N3
Type 3Type 3
Type 3Type 3Type 3
Std.Std.
Std.Std.Std.
1see guidelines for RxTh regimen2see guidelines for post radiotherapy ND (slide 33)3see guidelines for post-operative radiotherapy
Oropharynx 17Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: vallecula Evidence Option
l T1, N0, M0-surgery (T+N bilateral) ± RxTh1, if medically fitted-RxTh (T+N bilateral)-RxTh (T+N bilateral) + brachyth (T)-bilateral ND ± RxTh (T±N)± brachyth (T)
l T1, N1,M0-surgery (T+N bilateral) ± RxTh1, if medically fitted-RxTh (T+N bilateral)-bilateral ND ± RxTh (T±N) ± brachyth (T)
Type 3Type 3Type 3Type 3
Type 3Type 3Type 3
Std.Std.Std.Std.
Std.Std.Std.
1 see guidelines for post-operative radiotherapy
Oropharynx 18Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: vallecula Evidence Option
l T2, N0-N1, M0-surgery (T+N bilateral) ± RxTh, if medically fitted-"moderately advanced" RxTh protocol" (T+N)1±ND2
l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N)1 + ND2
-surgery (T) + bilateral ND ± RxTh3
-unilateral (bilateral) ND + RxTh (T+N):e.g.T1-T2,N3
Type 3Type 3
Type 3Type 3Type 3
Std.Std.
Std.Std.Std.
1see guidelines for RxTh regimen2see guidelines for post radiotherapy ND (slide 33)3see guidelines for post-operative radiotherapy
Oropharynx 19Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: tonsillar Fossa Evidence Option
l T1, N0, M0-surgery (T+N unilateral) ± RxTh1
-RxTh (T+N unilateral)-RxTh (T+N unilateral) ± brachyth (T)-unilateral ND ± RxTh (T±N) ± brachyth (T)
l T1, N1,M0-surgery (T+N unilateral) ± RxTh1
-RxTh (T+N unilateral)-unilateral ND ± RxTh (T±N) ± brachyth (T)
Type 3Type 3Type 3Type 3
Type 3Type 3Type 3
Std.Std.Std.Std.
Std.Std.Std.
1 see guidelines for post-operative radiotherapy
Oropharynx 20Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: Tonsillar fossa Evidence Option
l T2, N0-N1, M0:-surgery (T+N unilateral) ± RxTh1, if medically fitted-"moderately advanced" RxTh protocol" (T+N unilateral)2±ND3
l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N) + ND3
-surgery (T) + unilateral (bilateral) ND ± RxTh1
-unilateral (bilateral) ND + RxTh (T+N): e.g. T1-T2, N3
Type 3Type 3
Type 3Type 3Type 3
Std.Std.
Std.Std.Std.
1see guidelines for post-operative radiotherapy2see guidelines for RxTh regimen3see guidelines for post radiotherapy ND (slide 33)
Oropharynx 21Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: soft palate / uvula Evidence Option
l T1, N0, M0-surgery (T+N bilateral) ± RxTh1
-RxTh (T+N bilateral)-RxTh (T+N bilateral) + brachyth (T)-bilateral ND ± RxTh (T±N) ± brachyth (T)
l T1, N1,M0-surgery (T+N bilateral) ± RxTh1
-RxTh (T+N bilateral)-bilateral ND ± RxTh (T±N) ± brachyth (T)
Type 3Type 3Type 3Type 3
Type 3Type 3Type 3
Std.Std.Std.Std.
Std.Std.Std.
1 see guidelines for post-operative radiotherapy
Oropharynx 22Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Treatment: general strategy: soft palate / uvula Evidence Option
l T2, N0-N1, M0:-"moderately advanced" RxTh protocol"(T+N bilateral)1 ± ND2
-surgery (T+N bilateral) ± RxTh3
l T1-T4, ≥ N2a, M0-"locally advanced" RxTh protocol (T+N bilateral)1 + ND2
-surgery (T) + bilateral ND ± RxTh3
-unilateral (bilateral) ND + RxTh (T+N): e.g. T1-T2, N3
Type 3Type 3
Type 3Type 3Type 3
Std.Ind.
Std.Ind.Ind.
1see guidelines for RxTh regimen2see guidelines for post radiotherapy ND (slide 33)3see guidelines for post-operative radiotherapy
Oropharynx 23Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: general strategy: posterior pharyngeal wall Evidence Option
l T1, N0, M0-surgery (T+N bilateral) + RxTh1
-RxTh (T+N bilateral)l T1, N1,M0
-surgery (T+N bilateral) + RxTh1
-RxTh (T+N bilateral) ± ND2
Type 3Type 3
Type 3Type 3
Std.Std.
Std.Std.
1 see guidelines for post-operative radiotherapy 2 see guidelines for post radiotherapy ND (slide 33)
Oropharynx 24Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Treatment: general strategy: posterior pharyngeal wall Evidence Option
l T2, N0-N1, M0:-"moderately advanced" RxTh protocol" (T+N bilateral)1 ± ND2
-surgery (T+N bilateral) + RxTh3
l T1-T4, N2a-N3, M0-"locally advanced" RxTh protocol (T+N bilateral) + ND2
-surgery (T) + bilateral ND + RxTh3
-unilateral (bilateral) ND + RxTh (T+N): e.g. T1-T2, N3
Type 3Type 3
Type 3Type 3Type 3
Std.Std.
Std.Std.Std.
1see guidelines for RxTh regimen2see guidelines for post radiotherapy ND (slide 33)3see guidelines for post-operative radiotherapy
Oropharynx 25Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: surgical procedure of the “T” site:base of tongue
Evidence Option
l T1: - partial basiglossectomy by mandibular osteotomy- endoscopic microexcision by oral approach
only for small, well limited and well exposedtumor
l T2-T4: - partial vs subtotal basiglossectomy bymandibular ostetomy extended to upon tumor extension1
- Lateral pharyngectomy- Glossectomy (mobile tongue)- Laryngectomy
1 when the whole base of tongue need to be removed total laryngectomy should be considered in most cases for functional reasons
Type 3Type 3
Type 3
Std.Indiv.
Std.
Oropharynx 26Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: surgical procedure of the “T” site:Vallecula
Evidence Option
l T1: - extended supraglottic laryngectomy- endoscopic laser microexcision only for smallwell limited and well exposed tumor
l T2: - extended supraglottic laryngectomy- total laryngectomy: - for patient non suitable
for partial laryngectomy for medical reasons- when large resction of base of tongue is
requiredl T3-T4: - total laryngectomy + basiglossectomy
Type 3Type 3
Type 3Type 3
Type 3
Type 3
Std.Indiv.
Std.Std.
Std.
Std.
Oropharynx 27Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: surgical procedure of the “T” site:Tonsila fossa
Evidence Option
l T1: - partial pharyngectomy by oral approach(tonsillectomy, extended tonsillectomy)
l T2-T4: - partial pharyngectomy by oral approach (for veryselected T2)
- partial pharyngectomy by mandibular osteotomyextended to ( upon tumor extension)1. Soft palate2. Basiglossectoly3. Glossectomy4. Rhino-pharyngectomy
Type 3
Type 3
Type 3
Std.
Indiv.
Std.
Oropharynx 28Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: surgical procedure of the “T” site:Soft palate-uvula
Evidence Option
l T1: - local excision by oral approachl T2-T4: - partial pharyngectomy by oral approach (for very
selected T2) - partial pharyngectomy by mandibular osteotomy extended to ( upon tumor extension)
1. Soft palate2. Basiglossectoly3. Glossectomy4. Rhino-pharyngectomy
Type 3Type 3
Type 3
Std.Indiv.
Std.
Oropharynx 29Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: surgical procedure of the “T” site:Posterior pharyngeal wall
Evidence Option
l T1: - partial pharyngectomy by oral approach- laser microexcision
l T2: - oral approach: very selected T2- pharyngectomy by mandibulotomy
l T3-T4: - total pharyngectomy + total laryngectomy(in most cases)
Type 3Type 3Type 3Type 3Type 3
Std.Indiv.Indiv.Std.Std.
Oropharynx 30Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
StdStd..StdStd..
InvestInvest..
Type CType CType CType CType 3Type 3
•• N site: N site: unilateralunilateral or or bilateralbilateral ND ND accordingaccording to Tto Tlocalisationlocalisation
––N0: N0: selectiveselective ND (IIND (II--IV or IIV or I--IV)IV)11
–– N1N1--N3: radical N3: radical modifiedmodified / radical ND / / radical ND / extendedextended RNDRND–– SentinelSentinel nodenode biopsybiopsy
11See See clinicalclinical targettarget volume for the volume for the nodesnodes ((slideslide 32)32)
Option Option EvidenceEvidencePrimaryPrimary treatmenttreatment: : surgicalsurgical procedureprocedure of the «of the « NN » site» site
Oropharynx 31Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Primary treatment: RxTh regimen Evidence Option
l Target volumesT: CTV = GTV + 1.5-0.5 cm marginN: see table on node levels according to T site
l Technique-conformal radiotherapy-IMRT radiotherapy
l Dose / fractionation / treatment timel Early stage:1
-prophylactic dose: 50 Gy,-therapeutic dose: 66-70 Gy, 2 Gy daily
l “moderately advanced"2 / "locally advanced"3 stage-on protocol: GORTEC 99-02 / IMCL CP02-9815-off protocol: moderately accelerated regimen
(concomitant boost)l post-operative RxTh
-dose: 60-64 Gy, 2 Gy daily4
Type 3Type 3
Type CType C
-Type 1
Type 2
Std.Invest.
Std.Std.
Invest.Std.
Std.1T1 N0-N12T2 N0-N13any T N2a-N34See guidelines for post-operative radiotherapy
Oropharynx 32Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Target Volumes: Target Volumes: oropharynxoropharynxLevel of evidence : type 3 / option : standardLevel of evidence : type 3 / option : standard
Stage Ipsilateral neck Controlateral neck
N0-N1 (Ib1)-II-III-IV + RP for post. II-III-IV + RP for post. pharyngeal wall tumor pharyngeal wall tumor
N2a-N2b Ib-II-III-IV-V +RP II-III-IV + RP for post. pharyngeal wall tumor
N2c According to N stage on According to N stage oneach side of the neck each side of the neck
N3 I-II-III-IV-V +RP ± adjacent II-III-IV + RP for post. structures according to clinical pharyngeal wall tumor
and radiological data
1Ib only if extension to oral cavity
Oropharynx 33Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
StdStd..Type 3Type 3•• PlannedPlanned ND (SND, RMND, RND or ND (SND, RMND, RND or extendedextended ND) 2ND) 2--3 3 monthsmonths afterafter completioncompletion ofof RxThRxTh in patients in patients withwith aacontrolledcontrolled primaryprimary site site andand in case of in case of residualresidual or or suspected suspected
residualresidual, , resectableresectable N N diseasedisease irrespectiveirrespective ofof thethe initial N initial N stagestage
OptionOptionEvidenceEvidencePrimary treatment: neck dissection following a primary radiotherapy
Oropharynx 34Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Carcinoma of oropharynx
•• WorkWork--up procedureup procedure
•• TNM stagingTNM staging
•• Primary treatmentPrimary treatment
•• FollowFollow--upup
•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease
•• ReferencesReferences
Oropharynx 35Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Follow-up Evidence Option
l Clinical examination-fiberoptic examination and neck palpation every 2 months (first 2 years), every 6 months (3rd-5th year), then every year (> 5 years)-dental examination every 6 months
l Imaging-chest X-ray every year
l Laboratory tests-thyroid function (TSH) every year if radiotherapy delivered
l Evolution of late toxicity (EORTC/RTOG) scale
Type C
Type C
Type C
Type C
Type C
Std.
Std.
Std.
Std.
Std.
Oropharynx 36Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Carcinoma of oropharynx
•• WorkWork--up procedureup procedure
•• TNM stagingTNM staging
•• Primary treatmentPrimary treatment
•• FollowFollow--upup
•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease
•• ReferencesReferences
Oropharynx 37Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Salvage treatment for recurrent disease: general principle
Treatment will depend on:l Site and extension (rTNM stage)l Previous treatment(s)l Performance statusl Patient wishes
Oropharynx 38Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Salvage treatment for recurrent disease Evidence Option
l anyT-N0-M0-surgery ± RxTh1
-RxTh1 / brachyth (T < 3 cm)-chemotherapy
l T0-anyN-M0-ND ± RxTh1
-RxTh1
-chemotherapyl AnyT-anyN-M0
-surgery ± RxTh1
-chemotherapy-best supportive care
l Metastasis-chemotherapy-best supportive care
Type CType CType C
Type CType CType C
Type CType CType C
Type CType C
Std.Indiv.Indiv.
Std.Std.
Indiv.
Std.Indiv.Indiv.
Std.Std.
1depending on previous radiotherapy ; see guidelines for post-operative radiotherapy
Oropharynx 39Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
Carcinoma of oropharynx
•• WorkWork--up procedureup procedure
•• TNM stagingTNM staging
•• Primary treatmentPrimary treatment
•• FollowFollow--upup
•• Treatment of recurrent and/or Treatment of recurrent and/or metastaticmetastatic diseasedisease
•• ReferencesReferences
Oropharynx 40Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
ReferencesReferences• AJCC Cancer StagingManual fifth edition. Lippincott Williams & Wilkins, Philadelphia, 1997• Amdur RJ, Mendenhall WM, Parsons JT, Isaacs JH Jr, Million RR, Cassisi NJ. Carcinoma of the soft palate treated with irradiation:
analysis of results and complications. Radiother Oncol. 1987 Jul;9(3):185-94.• Bataini JP, Asselain B, Jaulerry C, Brunin F, Bernier J, Pontvert D, Lave C. A multivariate primary tumour control analysis
in 465 patients treated by radical radiotherapy for cancer of the tonsillar region: clinical and treatment parameters as prognostic factors. Radiother Oncol 1989;14:265-77
• Calais G, Goga D, Chauvet B, Carand G, Beutter P, Le Floch O. Carcinoma of the soft palate and uvula. An analysis of the results and the reasons for failures. A study of 76 cases. Rev Stomatol Chir Maxillofac 1988;89:306-10
• Calais G, Reynaud-Bougnoux A, Bougnoux P, Le Floch O. Squamous cell carcinoma of the base of the tongue: results of treatment in 115 cases. Br J Radiol 1989;62:849-53
• Calais G, Alfonsi M, Bardet E, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Oudinot P, Bertrand P. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stageoropharynx carcinoma. J Natl Cancer Inst 1999;91:2081-6
• Cooper JS, Farnan NC, Asbell SO, Rotman M, Marcial V, Fu KK, McKenna WG, Emami B. Recursive partitioninganalysis of 2105 patients treated in Radiation Therapy Oncology Group studies of head and neck cancer. Cancer 1996;77:1905-11
• Crook J, Mazeron JJ, Marinello G, Martin M, Raynal M, Calitchi E, Faraldi M, Ganem G, Le Bourgeois JP, Pierquin B. Combined external irradiation and interstitial implantation for T1 and T2 epidermoid carcinomas of base of tongue: the Creteil experience (1971-1981). Int J Radiat Oncol Biol Phys 1988;15:105-14
• Dubray B, Mosseri V, Brunin F, Jaulerry C, Poncet P, Rodriguez J, Brugere J, Point D, Giraud P, Cosset JM. Anemia isassociated with lower local-regional control and survival after radiation therapy for head and neck cancer: a prospective study. Radiology 1996;201:553-8
• Esche BA, Haie CM, Gerbaulet AP, Eschwege F, Richard JM, Chassagne D. Interstitial and external radiotherapy in carcinoma of the soft palate and uvula. Int J Radiat Oncol Biol Phys 1988;15:619-25
• Evans JF, Shah JP. Epidermoid carcinoma of the palate. Am J Surg 1981;142:451-5• Fayos JV, Morales P. Radiation therapy of carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys 1983;9:139-44• Fijuth J, Mazeron JJ, Le Pechoux C, Piedbois P, Martin M, Haddad E, Calitchi E, Pierquin B, Le Bourgeois JP. Second
head and neck cancers following radiation therapy of T1 and T2 cancers of the oral cavity and oropharynx. Int J RadiatOncol Biol Phys 1992;24:59-64
Oropharynx 41Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
ReferencesReferences• Foote RL, Olsen KD, Davis DL, Buskirk SJ, Stanley RJ, Kunselman SJ, Schaid DJ, DeSanto LW. Base of tongue
carcinoma: patterns of failure and predictors of recurrence after surgery alone. Head Neck 1993;15:300-7• Fowler JF, Lindstrom MJ. Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys
1992;23:457-67• Galati LT, Myers EN, Johnson JT. Primary surgery as treatment for early squamous cell carcinoma of the tonsil. Head
Neck 2000;22:294-6• Gehanno P, Kebaili C, Guedon C, Moisy N, Sichel JY. Primary transmaxillary buccopharyngectomy and recovery
transmaxillary buccopharyngectomy in giant cancers of the tonsilar region. Apropos of 120 cases. Ann Otolaryngol ChirCervicofac 1987;104:329-36
• Gregoire V, Coche E, Cosnard G, Hamoir M, Reychler H. Selection and delineation of lymph node target volumes in headand neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgicalexperience. Radiother Oncol 2000;56:135-50
• Harrison LB, Zelefsky MJ, Pfister DG, Carper E, Raben A, Kraus DH, Strong EW, Rao A, Thaler H, Polyak T, Portenoy R. Detailed quality of life assessment in patients treated with primary radiotherapy for squamous cell cancer of the base of the tongue. Head Neck 1997;19:169-75
• Harrison LB, Zelefsky MJ, Armstrong JG, Carper E, Gaynor JJ, Sessions RB. Performance status after treatment for squamous cell cancer of the base of tongue--a comparison of primary radiation therapy versus primary surgery. Int J Radiat Oncol Biol Phys 1994;30:953-7
• Horiot JC, Le Fur R, N'Guyen T, Chenal C, Schraub S, Alfonsi S, Gardani G, Van Den Bogaert W, Danczak S, Bolla M, et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 1992;25:231-41
• Housset M, Baillet F, Dessard-Diana B, Martin D, Miglianico L. A retrospective study of three treatment techniques for T1-T2 base of tongue lesions: surgery plus postoperative radiation, external radiation plus interstitial implantation andexternal radiation alone. Int J Radiat Oncol Biol Phys 1987;13:511-6
• Jaulerry C, Brunin F, Rodriguez J, Bataini JP, Brugere J. [Carcinomas of the posterior pharyngeal wall. Experience of the Institut Curie. Analysis of the results of radiotherapy]. Ann Otolaryngol Chir Cervicofac 1986;103:559-63
Oropharynx 42Mar. 2006
Catholic University of Louvain, St - Luc University HospitalHead and Neck Oncology Programme
ReferencesReferences• Keus RB, Pontvert D, Brunin F, Jaulerry C, Bataini JP. Results of irradiation in squamous cell carcinoma of the soft palate
and uvula. Radiother Oncol 1988;11:311-7• Kraus DH, Vastola AP, Huvos AG, Spiro RH. Surgical management of squamous cell carcinoma of the base of the
tongue. Am J Surg 1993;166:384-8• Lee DJ, Cosmatos D, Marcial VA, Fu KK, Rotman M, Cooper JS, Ortiz HG, Beitler JJ, Abrams RA, Curran WJ, et al.
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