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Published on: December 5, 2025
Relapse Patterns After Flap-Sparing Postoperative Radiotherapy in Oral Cavity Cancer
Dongchan Kim1, Donghyun Kim1,2, Wontaek Kim1,2
1Department of Radiation Oncology, Pusan National University Hospital, Busan, Korea.
Background:
This study evaluates relapse patterns and treatment outcomes in oral cavity carcinoma (OCC) patients treated with flap-sparing radiotherapy (RT).
Methods:
Patients treated with surgery and immediate free-flap reconstruction followed by RT due to OCC between 2018 and 2024 were analyzed retrospectively. During target volume delineation, the high-risk clinical target volume (CTV) was the native tissue-flap interface with an additional isotropic margin of 10 mm. We estimated the cumulative incidence and geometric patterns of local failures.
Results:
Thirty-four patients matched the inclusion criteria. Median follow-up was 44 months. Three patients experienced local recurrences. Two relapses occurred at the native tissue-flap junction, with no intraflap failure. Three cases of Grade 3 acute oral mucositis, two cases of late Grade 3 dysphagia, and two cases of osteoradionecrosis of the jaw were observed. Clinically significant flap-related complication was not reported.
Conclusion:
No intra-flap local recurrence was observed after flap-sparing RT. The entire flap does not need to be intentionally covered in the CTV. Further investigation of planning optimization for the reconstructed flap is needed.