110 Chapter 5 Table 1 – Continued n = 358 Tumor stage group (n; %) Stage 0 (cis) 1 (0) Stage I 62 (18) Stage II 63 (18) Stage III 91 (26) Stage IV 134 (38) Missing 7 Type of tumor (n; %) Mucosal 289 (81) Salivary gland 35 (10) Skin, incl. Melanoma 22 (6) Other types of tumor 12 (3) Abbreviation: SD, standard deviation; IQR, interquartile range; TNM-classification: T, tumor; N, node; M, metastasis classification according to the 8th edition.[15, 16] Radiotherapy RT was delivered using volumetric modulated arc therapy (VMAT) five days per week for six or seven weeks, to a total dose of 66 to 70Gy in 33 to 35 fractions depending on the RT setting: adjuvant versus primary RT. Twenty-four patients underwent RT in a randomized trial on dose-escalation for the primary tumor (ARTFORCE, clinicaltrials.gov ID NCT01504815) in which the FDG-avid part of the primary tumor was irradiated at a total dose of 84Gy [19]. If indicated, RT was combined with systemic therapy, including cisplatin (CRT) or cetuximab (BRT) [20]. Dental assessment According to national standard procedures, dental assessment of potential oral sources of infection was performed by oral and radiographic examination (e.g. orthopantomography), at least 14 days before the start of RT. Teeth with a poor prognosis due to extensive caries, advanced periodontal disease, and nonrestorable teeth were considered a potential source of infection. Radiographic abnormalities such as apical radiolucency, (partially) impacted teeth, residual root apices, root resorption, and dental cysts were also considered as potential source of infection [11-13]. Teeth with poor prognosis were treated by extraction if the expected radiation dose to the jaws was ≥40Gy [1, 13].
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