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689 poster The treatment result of nasopharyngeal carcinoma staging by MRI
Posters
in 39 (52.7%), RT in 8 (10.8%) followed by immunotherapy in 3 cases, and chemo-immunotherapy in 5 (6.8%). RT was given to total dose of 5-70 Gy (median 58 Gy), 1-5 Gy/fraction (median 2 Gy) to primary tumour in 45 pts and primary tumour+regional nodes in 2. Median follow-up was 19 months (CI 95%: 24-42). Overall lOS) and local relapsefree (LRFS) survivals were analyzed by Kaplan Meyer, univariate analysis by Log-Rank, and multivariate by Cox tests. The actuarial OS and LRFS were 46% and 39% at 2 years and 27% and 26% at 5 years. Local recurrence rate was 54.7% with a mean interval from diagnosis of 15.6 months (range 2-133). Regional relapse occurred in 21 pts (28.4%) and distant metastases in 26 (35.1%). On univariate analysis, age, gender and site of presentation had not prognostic significance. Stage I vs. I1-111appeared to be a significant prognostic factor for OS (p=0.001) but not for LRFS. S+RT vs. S appeared to be a favourable prognostic factor for LRFS (p=0.017) but not for OS (p=0.256). No correlation was found between total dose or fractionation and LC (p=0.368). These results were confirmed by multivariate analysis. LC and survival rates in this series were as poor as those shown in other literature studies. Stage I was a favourable prognostic factor possibly related to the lower incidence of distant metastases. Postoperative RT improved LC but not OS. Diagnosis at early stage and postoperative RT seem to be the main factors which can improve the prognosis of this rare and aggressive neoplasm. 688 poster Prospective study of postoperative simultaneous integrated boost (SIB) intensity-modulated radiotherapy for patients with head-and-neck cancers
L. Schlenqer 1, D. B~hmer~, J. Bohsung ~, /. Eichwurzef , D. Geismar~, R. Wurm ~, D. MunZ, V. Budach ~ ~Charit~ Campus Mitte, Department of Radiooncology, Berlin, Germany 2Charit6 Campus Mitte, Department of Nuclear Medicine, Berlin, Germany Material and methods: From April 2001 to June 2003, 20 patients with head and neck cancer patients requiring postoperative bilateral neck RT were treated with SIB (tumor bed 56 Gy in fractions of 2.24 Gy, elective lymph nodes 50 Gy in fractions of 2 Gy). The contra lateral paretid was spared. Acute and late toxicity was monitored according to common toxicity criteria 2.0 and RTOG score respectively. Parotid function was assessed by salivary gland scintigraphies performed. Life Quality was monitored by EORTC QLQC30 and QLQ-H&N35 Questionnaire. Results: Acute toxicity according CTC 2~0 was moderate. 2 patients had to interrupt the treatment due to dysphagia for 3 and 4 days, respectively. No grade 3 ° and 4 ° late toxicity was observed. 6 months after radiotherapy secretion and excretion function in the spared parotid was good compared to the non-spared parotid gland. To obtain a good chance (>70%) for preservation of its function on scintigraphy the mean parotid dose should be less than 20 Gy. 45% of patients had no, minimal or acceptable subjective xerostomia. No recurrence was seen near the spared parotid (3/20 Iocoregional recurrences). Conclusions: SIB with parotid sparing is feasible and prevents moderate or severe subjective xerostomia in a significant part of patients. In the spared parotids, nearly complete recovery is obtained after 6-12 months.
$299
689 poster The treatment staging by MRI
result of nasopharyngeal
carcinoma
C. Lid, J.T. Chang 1, C. Liao 2, T. Chert2, I. Chen 2, H. Wang 3 ~Chang Gung Memorial Hospital, Radiation Oncology, Taoyuan, Taiwan 2Chang Gung Memorial Hospital, ENT, Taoyuan, Taiwan 3Chang Gung Memorial Hospital, Hema-Oncology, Taoyuan, Taiwan Introduction: To evaluate the treatment result of nasepharyngeal carcinoma (NPC) patients staging magnetic resonance image (MRI) and treated conventional opposing radiation technique.
by by
Material and Method: There were 356 untreated nonmetastasis NPC patients with primary tumor and neck staging by MRI from July 1992 to December 1998. The median age was 46.7 and 251 patients were male. The staging was classified according 1997 stage, The stage distribution was stage I: 41 (11.5%) patients, stage I1: 130(36.5%), stage II1: 85(23.9%) and stage IV: 100 (28.1%). The radiation therapy was delivered by bil-opposing technique for 72 Gy (ranging from 66 to 76 Gy) by two stage reduced field technique. The radiation fraction size was 1.8-2 Gy and 5 fractions per week. Seventy four patients received high dose rate intracavity brachytherapy as boost. Sixty four patients received Cisplatin based agents as induction chemotherapy. Patient died within 2 years but without evidence of neck or distant metastasis was classified as persistent disease. Result: The 5 year disease specific survival was 89.7% for stage I, 80.8% for stage II, 67.9% for stage III and 56.6% for stage IV disease. Primary tumor recurrence was noted in 51 (14.4%) patients, persistent tumor in 26 (7.2%) patients and neck node recurrence in 22 (6.2%) patients. Eight three (23.3%) patients have distant metastasis. The most common metastasis site was bone, lung and liver. T4 lesion had significantly more local recurrence than T1-3 lesions, however, no difference between T2 and T3 lesions. Overall stage, T stage and N stage had significantly difference in metastasis prognosis. Conclusion: T4 lesion had significantly more local recurrence and advanced N stage had more distant metastasis in NPC patients who staging by MRI and were treated by conventional opposing technique. 690 poster Preservation of the parotids for medial and lateral oropharyngeal carcinomas: a comparison between 3 boost modalities: brachytherapy (BT), IntensityModulated Radiation Therapy (IMRT) and 3-Dimensional Conformal Radiotherapy (3D-CRT)
M. Lapevre, V. Marchesi, F. Ahmad, P. Graft, S. Racadot, A. Noel C. Marchal, P. Aletti, S. Hoffstetter, D. Peiffert Centre Alexis Vautrin, Radiotherapy, Vandoeuvre-les-Nancy, France Purpose: To report a dosimetry comparison in terms of parotids preservation between 3 boost modalities for a medial (Med) and a lateral (Lat) oropharyngeal carcinomas T1-2 NO (BT vs. IMRT vs. 3D - CRT) Material and methods: Two patients with vello-tonsillar region carcinomas (1 Med, 1 Lat) had undergone first step radiotherapy with a mean dose to the bilateral nodes and the tumor of 49.9 to 50.3 Gy with dynamic IMRT (Helios, Clinac EX 23, Varian). For Med, the mean doses to the right and left parotids were respectively 31.7 and 32 Gy. For the Lat, the
in 39 (52.7%), RT in 8 (10.8%) followed by immunotherapy in 3 cases, and chemo-immunotherapy in 5 (6.8%). RT was given to total dose of 5-70 Gy (median 58 Gy), 1-5 Gy/fraction (median 2 Gy) to primary tumour in 45 pts and primary tumour+regional nodes in 2. Median follow-up was 19 months (CI 95%: 24-42). Overall lOS) and local relapsefree (LRFS) survivals were analyzed by Kaplan Meyer, univariate analysis by Log-Rank, and multivariate by Cox tests. The actuarial OS and LRFS were 46% and 39% at 2 years and 27% and 26% at 5 years. Local recurrence rate was 54.7% with a mean interval from diagnosis of 15.6 months (range 2-133). Regional relapse occurred in 21 pts (28.4%) and distant metastases in 26 (35.1%). On univariate analysis, age, gender and site of presentation had not prognostic significance. Stage I vs. I1-111appeared to be a significant prognostic factor for OS (p=0.001) but not for LRFS. S+RT vs. S appeared to be a favourable prognostic factor for LRFS (p=0.017) but not for OS (p=0.256). No correlation was found between total dose or fractionation and LC (p=0.368). These results were confirmed by multivariate analysis. LC and survival rates in this series were as poor as those shown in other literature studies. Stage I was a favourable prognostic factor possibly related to the lower incidence of distant metastases. Postoperative RT improved LC but not OS. Diagnosis at early stage and postoperative RT seem to be the main factors which can improve the prognosis of this rare and aggressive neoplasm. 688 poster Prospective study of postoperative simultaneous integrated boost (SIB) intensity-modulated radiotherapy for patients with head-and-neck cancers
L. Schlenqer 1, D. B~hmer~, J. Bohsung ~, /. Eichwurzef , D. Geismar~, R. Wurm ~, D. MunZ, V. Budach ~ ~Charit~ Campus Mitte, Department of Radiooncology, Berlin, Germany 2Charit6 Campus Mitte, Department of Nuclear Medicine, Berlin, Germany Material and methods: From April 2001 to June 2003, 20 patients with head and neck cancer patients requiring postoperative bilateral neck RT were treated with SIB (tumor bed 56 Gy in fractions of 2.24 Gy, elective lymph nodes 50 Gy in fractions of 2 Gy). The contra lateral paretid was spared. Acute and late toxicity was monitored according to common toxicity criteria 2.0 and RTOG score respectively. Parotid function was assessed by salivary gland scintigraphies performed. Life Quality was monitored by EORTC QLQC30 and QLQ-H&N35 Questionnaire. Results: Acute toxicity according CTC 2~0 was moderate. 2 patients had to interrupt the treatment due to dysphagia for 3 and 4 days, respectively. No grade 3 ° and 4 ° late toxicity was observed. 6 months after radiotherapy secretion and excretion function in the spared parotid was good compared to the non-spared parotid gland. To obtain a good chance (>70%) for preservation of its function on scintigraphy the mean parotid dose should be less than 20 Gy. 45% of patients had no, minimal or acceptable subjective xerostomia. No recurrence was seen near the spared parotid (3/20 Iocoregional recurrences). Conclusions: SIB with parotid sparing is feasible and prevents moderate or severe subjective xerostomia in a significant part of patients. In the spared parotids, nearly complete recovery is obtained after 6-12 months.
$299
689 poster The treatment staging by MRI
result of nasopharyngeal
carcinoma
C. Lid, J.T. Chang 1, C. Liao 2, T. Chert2, I. Chen 2, H. Wang 3 ~Chang Gung Memorial Hospital, Radiation Oncology, Taoyuan, Taiwan 2Chang Gung Memorial Hospital, ENT, Taoyuan, Taiwan 3Chang Gung Memorial Hospital, Hema-Oncology, Taoyuan, Taiwan Introduction: To evaluate the treatment result of nasepharyngeal carcinoma (NPC) patients staging magnetic resonance image (MRI) and treated conventional opposing radiation technique.
by by
Material and Method: There were 356 untreated nonmetastasis NPC patients with primary tumor and neck staging by MRI from July 1992 to December 1998. The median age was 46.7 and 251 patients were male. The staging was classified according 1997 stage, The stage distribution was stage I: 41 (11.5%) patients, stage I1: 130(36.5%), stage II1: 85(23.9%) and stage IV: 100 (28.1%). The radiation therapy was delivered by bil-opposing technique for 72 Gy (ranging from 66 to 76 Gy) by two stage reduced field technique. The radiation fraction size was 1.8-2 Gy and 5 fractions per week. Seventy four patients received high dose rate intracavity brachytherapy as boost. Sixty four patients received Cisplatin based agents as induction chemotherapy. Patient died within 2 years but without evidence of neck or distant metastasis was classified as persistent disease. Result: The 5 year disease specific survival was 89.7% for stage I, 80.8% for stage II, 67.9% for stage III and 56.6% for stage IV disease. Primary tumor recurrence was noted in 51 (14.4%) patients, persistent tumor in 26 (7.2%) patients and neck node recurrence in 22 (6.2%) patients. Eight three (23.3%) patients have distant metastasis. The most common metastasis site was bone, lung and liver. T4 lesion had significantly more local recurrence than T1-3 lesions, however, no difference between T2 and T3 lesions. Overall stage, T stage and N stage had significantly difference in metastasis prognosis. Conclusion: T4 lesion had significantly more local recurrence and advanced N stage had more distant metastasis in NPC patients who staging by MRI and were treated by conventional opposing technique. 690 poster Preservation of the parotids for medial and lateral oropharyngeal carcinomas: a comparison between 3 boost modalities: brachytherapy (BT), IntensityModulated Radiation Therapy (IMRT) and 3-Dimensional Conformal Radiotherapy (3D-CRT)
M. Lapevre, V. Marchesi, F. Ahmad, P. Graft, S. Racadot, A. Noel C. Marchal, P. Aletti, S. Hoffstetter, D. Peiffert Centre Alexis Vautrin, Radiotherapy, Vandoeuvre-les-Nancy, France Purpose: To report a dosimetry comparison in terms of parotids preservation between 3 boost modalities for a medial (Med) and a lateral (Lat) oropharyngeal carcinomas T1-2 NO (BT vs. IMRT vs. 3D - CRT) Material and methods: Two patients with vello-tonsillar region carcinomas (1 Med, 1 Lat) had undergone first step radiotherapy with a mean dose to the bilateral nodes and the tumor of 49.9 to 50.3 Gy with dynamic IMRT (Helios, Clinac EX 23, Varian). For Med, the mean doses to the right and left parotids were respectively 31.7 and 32 Gy. For the Lat, the