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CT Response at 20 Gy Predicts Treatment Outcome for Head and Neck Squamous Cell Carcinoma (HNSCC)
E378
International Journal of Radiation Oncology Biology Physics
Conclusion: Proton beam radiation of the head and neck can provide excellent disease control along with great sparing of the OARs. Longer follow up is needed with a less heterogeneous population to validate this modality. In addition, with the advent of intensity modulated proton beam radiation, even better conformality of proton beam will hopefully improve the toxicity profiles of even the acute toxicities. Author Disclosure: J.H. Chang: Partner; Radiation Oncology Consultants. Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. N. Mohammed: Stock; ROC CyberKnife Investment, LLC. S.V. Yajnik: Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. Clinical Director; Medical Director. P.J. Sweeney: Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. Clinical Director; Medical Director. S. Samuel: None. W.F. Hartsell: Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. Clinical Director; Medical Director.
Conclusion: In recombinant human endostatin (Endostar) combined with chemoradiation therapy following induction chemotherapy, there was slightly higher recent efficiency of cervical lymph node metastasis. In recombinant human endostatin (Endostar) combined with chemoradiation therapy following induction chemotherapy, the common toxicity during conventional radiation therapy and chemotherapy for nasopharyngeal carcinoma were not increased and the treatment-related toxicity can be tolerated. Author Disclosure: Y.Y. Li: None. F. Jin: None.
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Purpose/Objective(s): Early indication of treatment failure may guide therapeutic intensification in HNSCC. We evaluated tumor volume and SUV parameters before and during radiation therapy. We hypothesized that lower tumor size and SUV during treatment would correlate with more favorable outcomes. Materials/Methods: HNSCC patients undergoing definitive (chemo)radiation were enrolled on an IRB-approved study. PET/CT scans were performed at initial simulation and 20 Gy. Gross tumor volumes for primary tumor (GTVP) and lymph nodes (GTVN) were delineated on pre- and intratreatment CT scans coregistered to PET images. Tumor volume, SUVmax, and SUVmean were measured. SUV was normalized to blood pool uptake. Treatment response and recurrence were assessed by diagnostic PET/CT at 12 weeks post-treatment, serial physical exam, and biopsy if indicated. Relative changes from baseline were assessed by Wilcoxon signed rank test. Distribution of measurements between groups was compared by Mann-Whitney test. Progression-free survival (PFS) was compared by logrank test. Results: 80 patients were evaluated: 55 oropharynx (47 p16+, 3 p16-, 5 unknown), 8 nasopharynx, 8 larynx, 5 oral cavity, 4 hypopharynx. 70 received concurrent chemotherapy. Stage distribution was 1 stage I, 3 stage II, 11 stage III, 57 stage IVA, and 8 stage IVB. Median follow-up was 21 months (IQR 11 e 29). Primary and nodal tumor volumes, SUVmax, and SUVmean at 20 Gy decreased significantly from baseline (p < 0.0001). Lower relative change in nodal volume was associated with residual disease (median -14% vs -42%, p < 0.01). Other relative changes were not associated with complete response post-treatment. 14 recurrences have occurred (4 LR, 6 LR & distant, 4 distant). Pre-treatment tumor volumes and SUV parameters were not associated with outcome. Patients with complete treatment response and no subsequent recurrence had significantly lower primary tumor SUVmax (median 5.9 vs 7.3, p < 0.05), primary tumor SUVmean (2.5 vs 3.5, p < 0.01), and GTVN (8.5 vs 20.9 cc, p < 0.01) at 20 Gy compared to patients with residual or recurrent disease. Patients with intra-treatment GTVN or nodal SUVmax at 20 Gy above the median value demonstrated significantly inferior PFS compared with patients with parameters below or equal to the median value (p Z 0.02 for both). Conclusion: Primary and nodal tumor size and SUV decreased significantly after 20 Gy. The results suggest that lower intra-treatment primary tumor SUVmax and SUVmean, as well as lower intra-treatment nodal tumor volume and nodal SUVmax, are associated with improved outcome for HNSCC. Additional follow-up is necessary. Analyses are ongoing to assess whether metabolic tumor volume and other SUV parameters are predictive of progression-free survival. Author Disclosure: Y.M. Mowery: None. I. Vergalasova: None. D.S. Yoo: None. D. Limon: None. S.K. Das: None. W.Y. Hara: None. D.M. Brizel: None.
Clinical Results of Recombinant Human Endostatin Combined With Chemotherapy and Radiation Therapy for Locally Advanced Nasopharyngeal Carcinoma: A Phase 2 Multi-Institutional Trial Y.Y. LI1 and F. Jin2; 1Department of Head and Neck Oncology Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang, China, 2Department of Head and Neck Oncology, Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang, KS, China Purpose/Objective(s): The purpose of this study is to compare the Shortterm efficacy and observe the feasibility and safety of recombinant human endostatin combined with chemoradiation therapy following induction chemotherapy for locally advanced nasopharyngeal carcinoma. Materials/Methods: Between December 2011 and March 2013, we enrolled patients older than 18 years with stage III-IVb nasopharyngeal carcinoma from 3 centers in Guizhou of China. We enrolled 54 patients into the study group, of whom were received recombinant human endostatin combined with chemoradiation therapy following induction chemotherapy. In the same period, other 61 patients were enrolled into the control group, of whom were received chemoradiation therapy following induction chemotherapy alone. Patients in both groups received the same two cycles of induction chemotherapy (Docetaxel 75mg/m2, DDP 80mg/m2), followed by two cycles of concurrent IMRT with DDP (80mg/m2 on days 1 and 22). The patients in the study group receive 2 cycles Endostar (7.5mg/m2 d8–d21 during neoadjuvant chemotherapy and d1-d14 during concurrent chemotherapy).The two groups were compared in terms of recent curative effect, overall survival (OS), progression-free of Survival (PFS), and acute side effects. Adverse events were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. The trial is registered at ClinicalTrials.gov, number NCT00408694. Results: The short-term curative effects between the study group and control group were compared. The complete remission rate of nasopharyngeal tumor (77.4%:72.9%, c2 Z 2.028, P Z 0.154). Compared with the control group, the study group improved the complete remission rate of cervical lymph node metastasis (75.5%:62.6%, c2 Z 4.363, P Z 0.037). During induction chemotherapy, III-IV grade of the most common adverse reactions are hematologic toxicity. We recorded no hemorrhages or grade 5 adverse events; two patients (4.7%) had a treatment-related grade 1 Ventricular arrhythmia in the study group. There were no significant differences in acute side effects of the two groups. The 3-year OS, PFS, DMFS, and RFS rate for the study group were 79.5%, 71%, 77%, and 79%,respectively, versus 83%, 81%, 76%, and 84% for the control group (P Z 0.76, 0.26, 0.655, 0.429).There were no significant differences in 3-year OS, PFS, DMFS, and RFS rate between the two groups (P>0.05).
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F-FDG PET/CT Response at 20 Gy Predicts Treatment Outcome for Head and Neck Squamous Cell Carcinoma (HNSCC) Y.M. Mowery,1 I. Vergalasova,1 D.S. Yoo,1 D. Limon,1 S.K. Das,2 W.Y. Hara,3 and D.M. Brizel1; 1Duke University Medical Center, Durham, NC, 2University of North Carolina at Chapel Hill, Chapel Hill, NC, 3 Stanford Hospital and Clinics, Stanford, CA
International Journal of Radiation Oncology Biology Physics
Conclusion: Proton beam radiation of the head and neck can provide excellent disease control along with great sparing of the OARs. Longer follow up is needed with a less heterogeneous population to validate this modality. In addition, with the advent of intensity modulated proton beam radiation, even better conformality of proton beam will hopefully improve the toxicity profiles of even the acute toxicities. Author Disclosure: J.H. Chang: Partner; Radiation Oncology Consultants. Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. N. Mohammed: Stock; ROC CyberKnife Investment, LLC. S.V. Yajnik: Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. Clinical Director; Medical Director. P.J. Sweeney: Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. Clinical Director; Medical Director. S. Samuel: None. W.F. Hartsell: Stock; Chicago Proton Therapy Investment, LLC, ROC CyberKnife Investment, LLC, Elk Grove Radiosurgery, Inc. Clinical Director; Medical Director.
Conclusion: In recombinant human endostatin (Endostar) combined with chemoradiation therapy following induction chemotherapy, there was slightly higher recent efficiency of cervical lymph node metastasis. In recombinant human endostatin (Endostar) combined with chemoradiation therapy following induction chemotherapy, the common toxicity during conventional radiation therapy and chemotherapy for nasopharyngeal carcinoma were not increased and the treatment-related toxicity can be tolerated. Author Disclosure: Y.Y. Li: None. F. Jin: None.
2932
Purpose/Objective(s): Early indication of treatment failure may guide therapeutic intensification in HNSCC. We evaluated tumor volume and SUV parameters before and during radiation therapy. We hypothesized that lower tumor size and SUV during treatment would correlate with more favorable outcomes. Materials/Methods: HNSCC patients undergoing definitive (chemo)radiation were enrolled on an IRB-approved study. PET/CT scans were performed at initial simulation and 20 Gy. Gross tumor volumes for primary tumor (GTVP) and lymph nodes (GTVN) were delineated on pre- and intratreatment CT scans coregistered to PET images. Tumor volume, SUVmax, and SUVmean were measured. SUV was normalized to blood pool uptake. Treatment response and recurrence were assessed by diagnostic PET/CT at 12 weeks post-treatment, serial physical exam, and biopsy if indicated. Relative changes from baseline were assessed by Wilcoxon signed rank test. Distribution of measurements between groups was compared by Mann-Whitney test. Progression-free survival (PFS) was compared by logrank test. Results: 80 patients were evaluated: 55 oropharynx (47 p16+, 3 p16-, 5 unknown), 8 nasopharynx, 8 larynx, 5 oral cavity, 4 hypopharynx. 70 received concurrent chemotherapy. Stage distribution was 1 stage I, 3 stage II, 11 stage III, 57 stage IVA, and 8 stage IVB. Median follow-up was 21 months (IQR 11 e 29). Primary and nodal tumor volumes, SUVmax, and SUVmean at 20 Gy decreased significantly from baseline (p < 0.0001). Lower relative change in nodal volume was associated with residual disease (median -14% vs -42%, p < 0.01). Other relative changes were not associated with complete response post-treatment. 14 recurrences have occurred (4 LR, 6 LR & distant, 4 distant). Pre-treatment tumor volumes and SUV parameters were not associated with outcome. Patients with complete treatment response and no subsequent recurrence had significantly lower primary tumor SUVmax (median 5.9 vs 7.3, p < 0.05), primary tumor SUVmean (2.5 vs 3.5, p < 0.01), and GTVN (8.5 vs 20.9 cc, p < 0.01) at 20 Gy compared to patients with residual or recurrent disease. Patients with intra-treatment GTVN or nodal SUVmax at 20 Gy above the median value demonstrated significantly inferior PFS compared with patients with parameters below or equal to the median value (p Z 0.02 for both). Conclusion: Primary and nodal tumor size and SUV decreased significantly after 20 Gy. The results suggest that lower intra-treatment primary tumor SUVmax and SUVmean, as well as lower intra-treatment nodal tumor volume and nodal SUVmax, are associated with improved outcome for HNSCC. Additional follow-up is necessary. Analyses are ongoing to assess whether metabolic tumor volume and other SUV parameters are predictive of progression-free survival. Author Disclosure: Y.M. Mowery: None. I. Vergalasova: None. D.S. Yoo: None. D. Limon: None. S.K. Das: None. W.Y. Hara: None. D.M. Brizel: None.
Clinical Results of Recombinant Human Endostatin Combined With Chemotherapy and Radiation Therapy for Locally Advanced Nasopharyngeal Carcinoma: A Phase 2 Multi-Institutional Trial Y.Y. LI1 and F. Jin2; 1Department of Head and Neck Oncology Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang, China, 2Department of Head and Neck Oncology, Affiliated Hospital of Guizhou Medical University, and Guizhou Cancer Hospital, Guiyang, KS, China Purpose/Objective(s): The purpose of this study is to compare the Shortterm efficacy and observe the feasibility and safety of recombinant human endostatin combined with chemoradiation therapy following induction chemotherapy for locally advanced nasopharyngeal carcinoma. Materials/Methods: Between December 2011 and March 2013, we enrolled patients older than 18 years with stage III-IVb nasopharyngeal carcinoma from 3 centers in Guizhou of China. We enrolled 54 patients into the study group, of whom were received recombinant human endostatin combined with chemoradiation therapy following induction chemotherapy. In the same period, other 61 patients were enrolled into the control group, of whom were received chemoradiation therapy following induction chemotherapy alone. Patients in both groups received the same two cycles of induction chemotherapy (Docetaxel 75mg/m2, DDP 80mg/m2), followed by two cycles of concurrent IMRT with DDP (80mg/m2 on days 1 and 22). The patients in the study group receive 2 cycles Endostar (7.5mg/m2 d8–d21 during neoadjuvant chemotherapy and d1-d14 during concurrent chemotherapy).The two groups were compared in terms of recent curative effect, overall survival (OS), progression-free of Survival (PFS), and acute side effects. Adverse events were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. The trial is registered at ClinicalTrials.gov, number NCT00408694. Results: The short-term curative effects between the study group and control group were compared. The complete remission rate of nasopharyngeal tumor (77.4%:72.9%, c2 Z 2.028, P Z 0.154). Compared with the control group, the study group improved the complete remission rate of cervical lymph node metastasis (75.5%:62.6%, c2 Z 4.363, P Z 0.037). During induction chemotherapy, III-IV grade of the most common adverse reactions are hematologic toxicity. We recorded no hemorrhages or grade 5 adverse events; two patients (4.7%) had a treatment-related grade 1 Ventricular arrhythmia in the study group. There were no significant differences in acute side effects of the two groups. The 3-year OS, PFS, DMFS, and RFS rate for the study group were 79.5%, 71%, 77%, and 79%,respectively, versus 83%, 81%, 76%, and 84% for the control group (P Z 0.76, 0.26, 0.655, 0.429).There were no significant differences in 3-year OS, PFS, DMFS, and RFS rate between the two groups (P>0.05).
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F-FDG PET/CT Response at 20 Gy Predicts Treatment Outcome for Head and Neck Squamous Cell Carcinoma (HNSCC) Y.M. Mowery,1 I. Vergalasova,1 D.S. Yoo,1 D. Limon,1 S.K. Das,2 W.Y. Hara,3 and D.M. Brizel1; 1Duke University Medical Center, Durham, NC, 2University of North Carolina at Chapel Hill, Chapel Hill, NC, 3 Stanford Hospital and Clinics, Stanford, CA