Marginal recurrences after selective targeting with intensity-modulated radiotherapy for oral tongue cancer

No universal consensus of optimal radiation target coverage for oral tongue cancer exists, and there is wide variability in practice. Some centers use intensity-modulated radiotherapy (IMRT) to selectively target only certain regions at risk while sparing others; however, patterns of failure after such selective targeting are rarely reported.

We critically examined the location of failure in 4 patients with stage III to IV oral tongue cancer who presented to our department with locoregional recurrence after receiving IMRT with selective radiation targeting at outside institutions. All 4 patients' cancer recurred marginally in regions that were not initially targeted, whereas the regions would have been targeted if comprehensive IMRT targeting had been used. The median time to recurrence was short (3.9 months; range, 1.2-10.1 months).

This case series highlights the occurrence of marginal failures after selective targeting with IMRT for oral tongue cancer and cautions against this practice unless further supporting evidence becomes available.