{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T03:01:53Z","timestamp":1789614113244,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100008130","name":"Pusan National University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study evaluates relapse patterns and treatment outcomes in oral cavity carcinoma (OCC) patients treated with flap\u2010sparing radiotherapy (RT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients treated with surgery and immediate free\u2010flap reconstruction followed by RT due to OCC between 2018 and 2024 were analyzed retrospectively. During target volume delineation, the high\u2010risk clinical target volume (CTV) was the native tissue\u2010flap interface with an additional isotropic margin of 10\u2009mm. We estimated the cumulative incidence and geometric patterns of local failures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010four patients matched the inclusion criteria. Median follow\u2010up was 44\u2009months. Three patients experienced local recurrences. Two relapses occurred at the native tissue\u2010flap 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\u2010related complication was not reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No intra\u2010flap local recurrence was observed after flap\u2010sparing 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70484","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:04:48Z","timestamp":1789610688000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relapse Patterns After Flap\u2010Sparing Postoperative Radiotherapy in Oral Cavity Cancer"],"prefix":"10.1002","author":[{"given":"Dongchan","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8062-4619","authenticated-orcid":false,"given":"Donghyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Korea"},{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wontaek","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Korea"},{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiho","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5143-3920","authenticated-orcid":false,"given":"Dahl","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Hospital  Busan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0757-8211","authenticated-orcid":false,"given":"Yongkan","family":"Ki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Korea"},{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9275-3197","authenticated-orcid":false,"given":"Jihyeon","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University School of Medicine  Yangsan Korea"},{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyeonghyo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8115-4113","authenticated-orcid":false,"given":"Sangil","family":"Pak","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Pusan National University Yangsan Hospital  Yangsan Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality World\u2010Wide for 36 Cancers in 185 Countries","volume":"74","author":"Bray F.","year":"2024","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1056\/NEJMoa032641","article-title":"Postoperative Irradiation With or Without Concomitant Chemotherapy for Locally Advanced Head and Neck Cancer","volume":"350","author":"Bernier J.","year":"2004","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1186\/s13014-017-0868-y","article-title":"Patterns of Locoregional Failure Following Post\u2010Operative Intensity\u2010Modulated Radiotherapy to Oral Cavity Cancer: Quantitative Spatial and Dosimetric Analysis Using a Deformable Image Registration Workflow","volume":"12","author":"Mohamed A. S. R.","year":"2017","journal-title":"Radiation Oncology"},{"key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.jcms.2015.02.021","article-title":"Marking of Tumor Resection Borders for Improved Radiation Planning Facilitates Reduction of Radiation Dose to Free Flap Reconstruction in Head and Neck Cancer Surgery","volume":"43","author":"Bittermann G.","year":"2015","journal-title":"Journal of Cranio\u2010Maxillofacial Surgery"},{"key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/0194599819839006","article-title":"Does Clearance of Positive Margins Improve Local Control in Oral Cavity Cancer? A Meta\u2010Analysis","volume":"161","author":"Bulbul M. G.","year":"2019","journal-title":"Otolaryngology and Head and Neck Surgery"},{"key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.oraloncology.2013.03.001","article-title":"Speech and Swallowing Following Tongue Cancer Surgery and Free Flap Reconstruction\u2013A Systematic Review","volume":"49","author":"Lam L.","year":"2013","journal-title":"Oral Oncology"},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.prro.2024.04.003","article-title":"Target Delineation in Postoperative Radiotherapy for Head and Neck Cancer After Flap Reconstruction","volume":"14","author":"Chen X. S.","year":"2024","journal-title":"Practical Radiation Oncology"},{"key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1002\/hed.28056","article-title":"Adjuvant Intensity Modulated Radiation Therapy With a Pedicled Flap Reconstruction in Oral Cavity Squamous Cell Carcinomas: Implications on Target Delineation","volume":"47","author":"Laskar S. G.","year":"2025","journal-title":"Head and Neck"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1080\/0284186X.2022.2036367","article-title":"On Behalf of the GORTEC. International Assessment of Interobserver Reproducibility of Flap Delineation in Head and Neck Carcinoma","volume":"61","author":"Beddok A.","year":"2022","journal-title":"Acta Oncologica"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.canrad.2020.06.024","article-title":"Postoperative Radiotherapy After Flap Reconstructive Surgery in Patients With Head and Neck Cancer: A Retrospective Monocentric Study With Flap Delineation to Assess Toxicity and Relapse","volume":"24","author":"G\u00e9rard M.","year":"2020","journal-title":"Cancer Radioth\u00e9rapie"},{"key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.radonc.2013.10.010","article-title":"Delineation of the Neck Node Levels for Head and Neck Tumors: A 2013 Update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG Consensus Guidelines","volume":"110","author":"Gregoire V.","year":"2014","journal-title":"Radiotherapy and Oncology"},{"key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.radonc.2020.08.025","article-title":"On Behalf of the GORTEC. Flap Delineation Guidelines in Postoperative Head and Neck Radiation Therapy for Head and Neck Cancers","volume":"151","author":"Guevelou J. L.","year":"2020","journal-title":"Radiotherapy and Oncology"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1016\/S0360-3016(99)00550-7","article-title":"Patterns of Local\u2010Regional Recurrence Following Parotid\u2010Sparing Conformal and Segmental Intensity\u2010Modulated Radiotherapy for Head and Neck Cancer","volume":"46","author":"Dawson L. A.","year":"2000","journal-title":"International Journal of Radiation Oncology, Biology, Physics"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"3916","DOI":"10.1002\/hed.25928","article-title":"Patterns of Local Recurrence After Curative Resection and Reconstruction for Oropharyngeal and Oral Cancers: Implications for Postoperative Radiotherapy Target Volumes","volume":"41","author":"Cho Y.","year":"2019","journal-title":"Head and Neck"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2024.1379861","article-title":"Reconstructive Flap Surgery in Head and Neck Cancer Patients: An Interdisciplinary View of the Challenges Encountered by Radiation Oncologists in Postoperative Radiotherapy","volume":"14","author":"Thariat J.","year":"2024","journal-title":"Frontiers in Oncology"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.1186\/1748-717X-7-175","article-title":"Outcome and Patterns of Failure After Postoperative Intensity Modulated Radiotherapy for Locally Advanced or High\u2010Risk Oral Cavity Squamous Cell Carcinoma","volume":"7","author":"Geretschlager A.","year":"2012","journal-title":"Radiation Oncology"},{"key":"e_1_2_11_18_1","doi-asserted-by":"crossref","DOI":"10.1259\/bjr.20140795","article-title":"Locoregional Recurrences After Post\u2010Operative Volumetric Modulated Arc Radiotherapy (VMAT) in Oral Cavity Cancers in a Resource Constrained Setting: Experience and Lessons Learned","volume":"88","author":"Chakraborty S.","year":"2015","journal-title":"British Journal of Radiology"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.joms.2011.04.014","article-title":"Radiotherapy Deteriorates Postoperative Functional Outcome After Partial Glossectomy With Free Flap Reconstruction","volume":"70","author":"Shin Y. S.","year":"2012","journal-title":"Journal of Oral and Maxillofacial Surgery"},{"key":"e_1_2_11_20_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.canrad.2025.104642","article-title":"Patterns of Relapse After Postoperative Radiotherapy in Patients With Oral Cavity Cancer and a Flap","volume":"29","author":"Blache A.","year":"2025","journal-title":"Cancer Radioth\u00e9rapie"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"e318","DOI":"10.1016\/S1470-2045(24)00067-6","article-title":"Assessment of Endpoint Definitions in Curative\u2010Intent Trials for Mucosal Head and Neck Squamous Cell Carcinomas: Head and Neck Cancer International Council Recommendations","volume":"25","author":"Lim A. M.","year":"2024","journal-title":"Lancet Oncology"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70484","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70484","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70484","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:04:51Z","timestamp":1789610691000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70484"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":20,"alternative-id":["10.1002\/hed.70484"],"URL":"https:\/\/doi.org\/10.1002\/hed.70484","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"2026-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"hed.70484"}}