Treatment outcomes of (chemo) radiotherapy for oropharyngeal cancers: influence of the use of 15 MV X-rays in radiation boost

Using high energy X-rays (>10 MV) as a radiotherapy boost in treating oropharyngeal cancers (OPC) to reduce mandible radiation exposure may result in deterioration of disease control rates due to re-build-up of X-rays at the tumor surface. Therefore, we retrospectively compared the treatment outcomes and toxicities in OPC patients treated with radiotherapy using 15 MV and/or 4–6 MV X-rays as a boost. Between 2008 and 2014, 63 OPC patients received definitive 3-dimensional conformal radiotherapy. The median total dose was 70.2 (range, 46.8–75.6) Gy. The median follow-up period for surviving patients was 48 (range, 9–88) months. Twenty-one patients (33.3%) received a boost employing 15 MV X-ray in at least one beam during treatment, and 42 patients (66.7%) received only 4–6 MV X-rays. Local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS) rates and the incidence of osteoradionecrosis (ORN) in the mandible for the two cohorts were estimated using the Kaplan-Meier method and compared using the log-rank test. There were no statistically significant differences between the two cohorts in either treatment outcomes (3-year LC, 81% versus 75% [p=0.742]; 3-year LRC, 71% versus 71% [p=0.925]; 3-year DFS, 66% versus 66% [p=0.934]; 3-year OS, 65% versus 78% [p=0.321]) or incidence of grade >2 ORN in the mandible (9.5% versus 11.9% [p=0.883]). Employing 15 MV X-rays in a boost may provide comparable treatment outcomes to 4–6 MV X-rays. However, reduction in the incidence of ORN in the mandible was not demonstrated.