Radioterapia post-operatoria in pazienti con neoplasia localmente avanzata del distretto cervico-cefalico sottoposti a chirurgia demolitiva e ricostruzione con lembi: esperienza del gruppo oncologico testa-collo

The aim of this retrospective study was to evaluate the efficacy and acute and late toxicity of postoperative irradiation in patients affected by locally advanced head and neck cancer who underwent radical surgery with flap reconstruction. From January 2003 to January 2008, 27 patients affected by locally advanced head-neck cancer, treated with radical surgery with flap reconstruction, underwent 3D conformational radiotherapy. Twenty-three were males and 4 were females with mean age of 60.6 years (range 48-75 years). The cancer was placed in oral cavity in 12 patients (44.4%), in oropharynx in 2 patients (7.4%), in hypopharynx in 8 patients (29.6%) and in larynx in 5 patients (18.5%). All tumors were squamous. At staging we found T1N2b=3.7%, T2N0=11.1%, T2N1=11.1%, T2N2a=7.4%, T2N2b=3.7%, T2N2c=7.4%, T3N1=7.4%, T3N2b=11.1%, T3N2c=7.4%, T4aN0=7.4%, T4aN1=3.7%, T4aN2a=3.7%, T4aN2b=7.4%, T4aN2c=7.4%. The flaps were removed from radius (25.9%), pectoral (18.5%), forearm (14.8%), jejunum (14.8%), fibula (11.1%), thigh (11.1%) and platisma (3.7%). All patients were treated on surgical bed and bilateral cervical nodes (PTVII: 50-54 Gy). In 17 cases we defined also a PTVI (up to 66 Gy) on surgical bed if lips were infiltrated or on nodal seat if there was capsulary breaking. The dose was administered in fractions of 2 Gy for 5 days a week. At the end of treatment, all patients obtained completed remission of disease (CR). Out of totality of cases we observed disease free survival (DFS): 74.1% with medium follow up of 25.9 months, primary tumour relapse: 18.5%, nodal relapse: 2.7%, and distant metastases incidence: 2.7%. During treatment, G1-G2 mucositis, dermatitis, dysphagia, odynophagia, xerostomia, oedema and trismus were recorded but only two G3 events in 2 cases. All patients completed the treatment. No significant late toxicity was observed during the follow-up. None of the patients showed lip's necrosis or pain. Few studies about flap reconstruction and postoperative irradiation are reported in literature. Our data show good results in terms of disease-free survival rate and very limited acute and late toxicity, especially in irradiated flaps.