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EP-1027: Evaluation of induction chemotherapy followed by radiation therapy in advanced oropharyngeal cancers
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Electronic Poster: Clinical track: Head and Neck EP-1026 Clinical Outcomes of Taiwan cT4b OSCC: Toward the Identification of the Optimal Initial Treatment T.C. Yen1, C.T. Liao2, Y.W. Wen3, L.Y. Lee4, C.Y. Lin5, H.M. Wang6, C.H. Lin7 1 Chang Gung Memorial Hospital, Nuclear Medicine, Taoyuan, Taiwan 2 Chang Gung Memorial Hospital, OtorhinolaryngologyHead and Neck Surgery, Taoyuan, Taiwan 3 Chang Gung University, Clinical Informatics and Medical Statistics Research Center, Taoyuan, Taiwan 4 Chang Gung Memorial Hospital, Pathology, Taoyuan, Taiwan 5 Chang Gung Memorial Hospital, Radiation Oncology, Taoyuan, Taiwan 6 Chang Gung Memorial Hospital, Medical Oncology, Taoyuan, Taiwan 7 Chang Gung Memorial Hospital, Plastic and Reconstructive Surgery, Taoyuan, Taiwan Purpose or Objective The NCCN guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a non-surgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach. Material and Methods Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6%) had cT4b tumors. Of them, 327 (66%) received initial treatment with surgery, whereas 165 (34%) were initially treated with a non-surgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45% was considered as a favorable outcome.
Results Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (versus non-surgery; DSS, 51% versus 38%; OS, 43% versus 27%, respectively, p <0.001). Of the participants initially treated with surgery, patients with cN0-2 disease had better 5-year survival rates (DSS: cN0, 59%; cN1, 53%; cN2, 46%; OS: cN0, 49%; cN1, 50%; cN2, 37%) than those with cN3 disease (DSS: 0%; OS: 0%). Among cT4b patients who initially received a non-surgical treatment, subjects who subsequently underwent surgery showed better outcomes. Conclusion Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0-2 cases showing a good prognosis. Patients who initially received a non-surgical approach can subsequently be treated with surgery and achieve favorable outcomes. EP-1027 Evaluation of induction chemotherapy followed by radiation therapy in advanced oropharyngeal cancers R.K. Pothamsetty1, B.P. THALIATH1, R.R. GHOSH1 1 Kamala Nehru Memorial Hospital, Radiation Oncology, Allahabad, India Purpose or Objective 1. Evaluation of acute and late radiation morbidity using the RTOG criteria in both arms. 2. Evaluation of loco-regional failures, diffuse free survival and overall survival in both arms. Material and Methods The study design was a prospective, comparative, randomized double arm study involving patients of all age groups of both the sexes, Stage III and Stage IVA oropharyngeal cancer who were biopsy proven squamous cell carcinoma reported to Kamala Nehru Memorial Hospital, Allahabad from February 2014June 2015. They were subjected to induction chemotherapy as scheduled. Complete and partial responders were randomized into 2 arms: Arm A (Conventional external beam radiotherapy) and Arm B (Intensity modulated radiotherapy). Both the groups
S567 ESTRO 36 _______________________________________________________________________________________________
received 70 Gy /35 as per institutional protocol.
fractions
/7
weeks
Results Out of 54 patients only 46 patients (85%) completed NACT. The most common side effect encountered during induction chemotherapy is nausea and vomiting representing 24%, followed by anorexia representing 20%. After completion of induction chemotherapy we had observed radiologically 24%, 63% and 13% as complete, partial and non-responders respectively. Acute toxicities like skin reactions,mucosal reactions, xerostomia, pharyngitis/ hoarseness, upper GI side effects, and hematological complications are more in Arm A than Arm B. Patients in arm B has tolerated the local radiation therapy compared to the patients in arm A. The quality of life of patients in arm B compared to arm A was appreciable during the local treatment. At 6th month follow up local control, disease free survival, overall survival, found in arm Avs arm B was 45% vs 50%, 25% vs 35%, 85% vs 95% respectively. Progressive disease and lost to follow up was 15% vs 10%, 10% vs 5% respectively. Patients died in arm A vs arm B was 5% vs 0% respectively. Late radiation toxicities were assessed clinically at 6 months as per RTOG criteria and results had found not statistically significant.
Conclusion As observed in our study, 40 patients out of 54 has been down staged. Symptoms like swallowing, anorexia, tumor related pain, weight loss has been improved after induction chemotherapy. However, this study definitely showed down staging and better treatment tolerance towards IMRT arm in locally advanced oropharyngeal carcinoma. A long term study for longer follow up required for any statistically significant result. Better response can be expected in early stage disease EP-1028 MRI during radiotherapy: tumor geometry and changes in organs at risk for head-and-neck patients C. Grundmann1, K.A. Kessel1,2, S. Pigorsch1, S. Graf3, F. Nüsslin1, S.E. Combs1,2 1 Technische Universität München TUM, Department of Radiation Oncology, München, Germany 2 Helmholtz Zentrum München, Institute for Innovative Radiotherapy iRT, Neuherberg, Germany 3 Technische Universität München TUM, Department of Otorhinolaryngology, München, Germany Purpose or Objective The use of image-guided radiotherapy (IGRT) leads to a protection of OARs and a resulting reduction of side effects for the patient. The aim of this work is to make a statement about the relevance of MRI during radiotherapy (RT) and illustrate the importance for radiation oncology. Material and Methods In a retrospective analysis, for 17 patients with head-andneck-cancer, the volume of eight OARs relevant for swallowing was examined on MRI. Contouring was performed on MRI before, during and after radiation and the dose applied to the OARs was determined. Five of the 17 patients additionally participated in a voice and swallowing test on average 22.2 months after RT. Three questionnaires (Anderson Dysphagia Inventory (ADI-D), Voice Handicap Index, EORTC QLQ-H&N35) were used to evaluate subjective voice and swallowing disorders and the related quality of life. Additionally, fiberoptic endoscopic evaluation of swallowing (FEES) and a voice test were performed, including the assessment of the patient’s phonation and
Electronic Poster: Clinical track: Head and Neck EP-1026 Clinical Outcomes of Taiwan cT4b OSCC: Toward the Identification of the Optimal Initial Treatment T.C. Yen1, C.T. Liao2, Y.W. Wen3, L.Y. Lee4, C.Y. Lin5, H.M. Wang6, C.H. Lin7 1 Chang Gung Memorial Hospital, Nuclear Medicine, Taoyuan, Taiwan 2 Chang Gung Memorial Hospital, OtorhinolaryngologyHead and Neck Surgery, Taoyuan, Taiwan 3 Chang Gung University, Clinical Informatics and Medical Statistics Research Center, Taoyuan, Taiwan 4 Chang Gung Memorial Hospital, Pathology, Taoyuan, Taiwan 5 Chang Gung Memorial Hospital, Radiation Oncology, Taoyuan, Taiwan 6 Chang Gung Memorial Hospital, Medical Oncology, Taoyuan, Taiwan 7 Chang Gung Memorial Hospital, Plastic and Reconstructive Surgery, Taoyuan, Taiwan Purpose or Objective The NCCN guidelines recommend that patients with oral cavity squamous cell carcinoma (OSCC) and cT4b disease should be either included in clinical trials or treated with a non-surgical approach. However, surgery may be feasible in selected patients with adequate safety margins. Using the nationwide Taiwanese Cancer Registry Database, we examined the prognosis of cT4b OSCC patients in relation to their treatment approach. Material and Methods Of the 18,910 patients with previously untreated first primary OSCC identified between 2004 and 2010, 492 (2.6%) had cT4b tumors. Of them, 327 (66%) received initial treatment with surgery, whereas 165 (34%) were initially treated with a non-surgical approach. Of the latter group, 78 patients subsequently underwent surgery. A 5-year disease-specific survival (DSS) ≥45% was considered as a favorable outcome.
Results Better 5-year DSS and overall survival (OS) rates were observed in cT4b patients initially treated with surgery (versus non-surgery; DSS, 51% versus 38%; OS, 43% versus 27%, respectively, p <0.001). Of the participants initially treated with surgery, patients with cN0-2 disease had better 5-year survival rates (DSS: cN0, 59%; cN1, 53%; cN2, 46%; OS: cN0, 49%; cN1, 50%; cN2, 37%) than those with cN3 disease (DSS: 0%; OS: 0%). Among cT4b patients who initially received a non-surgical treatment, subjects who subsequently underwent surgery showed better outcomes. Conclusion Primary surgery is performed in approximately two-thirds of cT4b OSCC patients, with cN0-2 cases showing a good prognosis. Patients who initially received a non-surgical approach can subsequently be treated with surgery and achieve favorable outcomes. EP-1027 Evaluation of induction chemotherapy followed by radiation therapy in advanced oropharyngeal cancers R.K. Pothamsetty1, B.P. THALIATH1, R.R. GHOSH1 1 Kamala Nehru Memorial Hospital, Radiation Oncology, Allahabad, India Purpose or Objective 1. Evaluation of acute and late radiation morbidity using the RTOG criteria in both arms. 2. Evaluation of loco-regional failures, diffuse free survival and overall survival in both arms. Material and Methods The study design was a prospective, comparative, randomized double arm study involving patients of all age groups of both the sexes, Stage III and Stage IVA oropharyngeal cancer who were biopsy proven squamous cell carcinoma reported to Kamala Nehru Memorial Hospital, Allahabad from February 2014June 2015. They were subjected to induction chemotherapy as scheduled. Complete and partial responders were randomized into 2 arms: Arm A (Conventional external beam radiotherapy) and Arm B (Intensity modulated radiotherapy). Both the groups
S567 ESTRO 36 _______________________________________________________________________________________________
received 70 Gy /35 as per institutional protocol.
fractions
/7
weeks
Results Out of 54 patients only 46 patients (85%) completed NACT. The most common side effect encountered during induction chemotherapy is nausea and vomiting representing 24%, followed by anorexia representing 20%. After completion of induction chemotherapy we had observed radiologically 24%, 63% and 13% as complete, partial and non-responders respectively. Acute toxicities like skin reactions,mucosal reactions, xerostomia, pharyngitis/ hoarseness, upper GI side effects, and hematological complications are more in Arm A than Arm B. Patients in arm B has tolerated the local radiation therapy compared to the patients in arm A. The quality of life of patients in arm B compared to arm A was appreciable during the local treatment. At 6th month follow up local control, disease free survival, overall survival, found in arm Avs arm B was 45% vs 50%, 25% vs 35%, 85% vs 95% respectively. Progressive disease and lost to follow up was 15% vs 10%, 10% vs 5% respectively. Patients died in arm A vs arm B was 5% vs 0% respectively. Late radiation toxicities were assessed clinically at 6 months as per RTOG criteria and results had found not statistically significant.
Conclusion As observed in our study, 40 patients out of 54 has been down staged. Symptoms like swallowing, anorexia, tumor related pain, weight loss has been improved after induction chemotherapy. However, this study definitely showed down staging and better treatment tolerance towards IMRT arm in locally advanced oropharyngeal carcinoma. A long term study for longer follow up required for any statistically significant result. Better response can be expected in early stage disease EP-1028 MRI during radiotherapy: tumor geometry and changes in organs at risk for head-and-neck patients C. Grundmann1, K.A. Kessel1,2, S. Pigorsch1, S. Graf3, F. Nüsslin1, S.E. Combs1,2 1 Technische Universität München TUM, Department of Radiation Oncology, München, Germany 2 Helmholtz Zentrum München, Institute for Innovative Radiotherapy iRT, Neuherberg, Germany 3 Technische Universität München TUM, Department of Otorhinolaryngology, München, Germany Purpose or Objective The use of image-guided radiotherapy (IGRT) leads to a protection of OARs and a resulting reduction of side effects for the patient. The aim of this work is to make a statement about the relevance of MRI during radiotherapy (RT) and illustrate the importance for radiation oncology. Material and Methods In a retrospective analysis, for 17 patients with head-andneck-cancer, the volume of eight OARs relevant for swallowing was examined on MRI. Contouring was performed on MRI before, during and after radiation and the dose applied to the OARs was determined. Five of the 17 patients additionally participated in a voice and swallowing test on average 22.2 months after RT. Three questionnaires (Anderson Dysphagia Inventory (ADI-D), Voice Handicap Index, EORTC QLQ-H&N35) were used to evaluate subjective voice and swallowing disorders and the related quality of life. Additionally, fiberoptic endoscopic evaluation of swallowing (FEES) and a voice test were performed, including the assessment of the patient’s phonation and