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Purpose To discuss the role of proton beam therapy (PBT) in the treatment of patients with oropharyngeal squamous cell carcinoma (OPSCC). Materials and Methods A review of the pertinent literature. Results Proton beam therapy likely results in reduced acute and late toxicity as compared with intensity-modulated radiation therapy (IMRT). The extent of the reduced toxicity, which may be modest, depends on the endpoint and technical factors such as pencil beam versus passive scattered PBT and adaptive replanning. The disease control rates after PBT are likely similar to those after IMRT. Conclusion Proton beam therapy is an attractive option to treat patients with OPSCC. Whether it becomes widely available depends on access.

To evaluate the long-term disease control, survival, and complications after definitive radiotherapy (RT) alone or combined with adjuvant chemotherapy with or without planned neck dissection for base of tongue squamous cell carcinoma (SCC).We retrospectively reviewed the medical records of 467 patients treated at the University of Florida with definitive RT alone or combined with adjuvant chemotherapy between 1964 and 2011 for base of tongue SCC.Median follow-up was 5.6 years. Median total dose to the primary site was 74.4 Gy. Eighty-seven patients (19%) were treated with once-daily fractionation, and 380 (81%) received altered fractionation schedules. Intensity-modulated RT was used in 128 patients (27%). Chemotherapy was administered to 173 (37%) patients. Planned neck dissection after RT was performed in 226 patients (48%). Data regarding p16 pathway activation were available for 25 patients.At 5 years, the local, local-regional, and regional control rates were 85.5%, 80.0%, and 90.0%, respectively. The 5-year overall, cause-specific, and distant metastasis-free survival rates were 59.1%, 71.5%, and 84.1%, respectively. Sixty-four patients (14%) developed one or more severe late complications. Fifty patients (11%) required late gastrostomy tube placement.This study supports the continued use of RT alone or combined with adjuvant chemotherapy for patients with base of tongue SCC, as this treatment yields high rates of cause-specific survival and disease control, with a relatively low rate of late complications.4. Laryngoscope, 127:1589-1594, 2017.

OBJECTIVES Esthesioneuroblastoma is an uncommon cancer of the nasal cavity. We describe the outcomes for 26 patients treated with curative intent with photon radiotherapy (RT) at the University of Florida. METHODS Between May 1972 and June 2007, 26 patients received RT for previously untreated esthesioneuroblastoma of the nasal cavity. Sixteen patients were males and 10 were females with a median age of 55 years (range, 3 to 82 y). The modified Kadish stage distribution was: B, 7 patients; C, 17 patients; and D, 2 patients. Treatment modalities included the following: definitive RT, 5 patients; preoperative RT, 2 patients; and postoperative RT after resection, 19 patients. Elective neck irradiation (ENI) was performed in 17 (71%) of 24 N0 patients. RESULTS Rates of local control, cause-specific survival, and absolute overall survival at 5 years were 79%, 72%, and 69%, respectively. Overall survival among patients treated with definitive RT was 20% at 5 years, compared with 81% among those who underwent surgery and adjuvant RT (P=0.01). One (6%) of 17 patients who received ENI developed a recurrence in the neck and was successfully salvaged. Ultimate neck control was 100% at 5 years for patients who received ENI versus 69% among those not receiving ENI (P=0.0173). CONCLUSIONS Resection combined with adjuvant RT is more effective than surgery or RT alone in the treatment of esthesioneuroblastoma. ENI reduces the risk of regional relapse in patients with Kadish stage B and C cancers.

Marginal excision of soft tissue sarcoma (STS), defined as resection through the tumor pseudocapsule or surrounding reactive tissue, increases the likelihood of local recurrence and necessitates re-excision or postoperative radiation. However, its impact after preoperative radiation therapy (RT) remains unclear. This study therefore investigated the significance of marginal margins in patients treated with preoperative RT for extremity STS, reporting long-term local control and limb preservation endpoints.The records of 317 adults at the University of Florida with nonmetastatic extremity STS treated from 1980 to 2008 with preoperative RT as part of a limb conservation strategy were reviewed. The median follow-up was 4.7 years (8.3 years for living patients). The median tumor size was 10 cm (range, 2-36 cm), and 86% were high grade. The median RT dose was 50.4 Gy (range, 12.5-57.6 Gy). Margins were classified as wide/radical (n = 105), marginal (n = 179), contaminated (n = 15), positive (n = 17), or unknown (n = 1). Endpoints were local control (LC), amputation-free survival (AFS), cause-specific survival (CSS), and overall survival (OS).Five-year CSS and OS rates were 62% and 59%, respectively. Five-year LC and AFS was 93% and 89%, respectively. AFS by margin status was 64%, 83%, 97%, and 92% for positive, contaminated, marginal, and wide/radical margins, respectively (P.005). Marginal excision following preoperative RT resulted in equivalent LC and AFS compared with wide/radical margins.Marginal resection after preoperative RT does not compromise LC or AFS in extremity STS. This finding may be related to radiosterilization of tumor cells within the reactive zone following preoperative RT.

To report the outcomes after intensity-modulated radiotherapy (IMRT) for patients with oropharyngeal squamous cell carcinoma.Retrospective review.Between July 2001 and March 2007, a total of 130 patients were treated with definitive IMRT for squamous cell carcinoma of the oropharynx. Forty-seven patients (36%) had T3 (26 patients) or T4 (21 patients) cancers and 117 patients (90%) had overall stage III to IV disease. The fractionation schedules employed included the following: once daily, 12 patients (9%); hyperfractionation, three patients (2%); and concomitant boost, 115 patients (89%). Seventy-nine patients (61%) received adjuvant chemotherapy, and 54 patients (42%) underwent a planned neck dissection. Median follow-up was 3.5 years, (range, 0.2-7.7 years). Median follow-up for surviving patients was 3.8 years (range, 2.1-7.7 years).The 5-year local control rates were as follows: T1, 93%; T2, 91%; T3, 82%; T4, 67%; and overall, 87%. The 5-year local-regional control rates were as follows: stage I to II, 92%; stage III, 72%; stage IVA, 94%; stage IVB, 71%; and overall, 84%. The 5-year distant metastasis-free survival rate was 93%. The 5-year cause-specific and overall survival rates were 85% and 76%, respectively. Severe late complications occurred in 11 patients (8%).In our experience, IMRT resulted in local-regional control rates that are comparable to those achieved with more conventional techniques with a similar risk of severe complications.

To report outcome for patients treated with radiotherapy (RT) for basal cell carcinoma of the medial canthus.Retrospective review.Thirty-three patients treated with RT at the University of Florida between 1965 and 2005 for basal cell carcinoma of the medial canthus were retrospectively reviewed. RT was the primary treatment for gross disease in 70% of patients and for positive margin after resection in 30%. The prescribed dose was 50 to 60 Gy at 2.0 to 2.5 Gy per fraction.Surviving patients were followed for a median of 14 years. Tumor recurred at the primary site in 10%. There were no regional recurrences or distant metastases. The local control rate was 100% in patients treated with surgery followed by RT for positive margins. In patients treated with RT alone, the local control rate was 94% with de novo lesions and 67% if the lesion was recurrent after prior surgery. Cause-specific survival was 95% at 10 years; overall survival was 52% at 10 years. There were no severe complications. Chronic epiphora was present in 21% and chronic dry eye symptoms in 3%.With the proper technique, RT produces excellent results in several of these patients. Patients with recurrent tumors and gross disease at the time of RT have a suboptimal cure rate. Our plan is to increase the RT dose to 64.8 Gy at 1.8 Gy per fraction.