2827 Role of induction chemotherapy in the multimodal management of locally advanced epithelial sinonasal cancer

2827 Role of induction chemotherapy in the multimodal management of locally advanced epithelial sinonasal cancer

Abstracts S567 Progression-free survival at one and two years was not different, but at three and five years cisplatin was better (RR 0.62−95% CI 0.4...

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Abstracts

S567

Progression-free survival at one and two years was not different, but at three and five years cisplatin was better (RR 0.62−95% CI 0.44–0.86 and RR 0.68−95% CI 0.54–0.87, respectively). Locoregional recurrence rates were similar at one, three and five years. Survival rates at two, three and five years were better with cisplatin when all studies were included (RR 1.22−95% CI 1.01–1.46; RR 1.21−95% CI 1.03–1.43 and RR 1.13−95% CI 1.02–1.25, respectively), but not when the comparison was done only in the definitive chemoradiation prospective trials (5-years survival rate: RR 1.04−95% CI 0.91–1.19). Carboplatin was associated with a greater degree of mielotoxicity, especially thrombocytopenia (RR 2.54−95% CI 1.77–3.65) and with less nausea (RR 0.55−95% CI 0.40–0.75). Conclusions: Despite the poor quality of the comparative data available, cisplatin seems to be better than carboplatin in the treatment of patients with loco-regionally advanced squamous cell cancer of the head and neck. Evaluating only definitive chemoradiotherapy trials, there was no difference between the drugs. Conflict of interest: Advisory Board: R.A. de Mello − Pfizer adv board. 2827 POSTER Role of induction chemotherapy in the multimodal management of locally advanced epithelial sinonasal cancer P. Bossi1 , L. Pala1 , E. Orlandi2 , R. Granata1 , P. Battaglia3 , D. Lombardi4 , M. Guzzo5 , L. Locati1 , M. Barbara ` 6 , P. Quattrone7 , G. Calareso8 , P. Nicolai9 , P. Castelnuovo3 , N. Iacovelli2 , C. Bergamini1 , C. Resteghini1 , S. Alfieri1 , M. Imbimbo1 , L. Licitra1 . 1 Fondazione IRCCS Istituto Nazionale dei Tumori, Head and Neck cancer Medical Unit, Milan, Italy; 2 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiotherapy, Milan, Italy; 3 Ospedale di Circolo, Head and Neck Surgery, Varese, Italy; 4 Spedali Civili, Head and Neck Surgery, Brescia, Italy; 5 Fondazione IRCCS Istituto Nazionale dei Tumori, Head and Neck Surgery, Milan, Italy; 6 University, Statistic and Biometry, Palermo, Italy; 7 Fondazione IRCCS Istituto Nazionale dei Tumori, Pathology, Milan, Italy; 8 Fondazione IRCCS Istituto Nazionale dei Tumori, Radiology, Milan, Italy; 9 University, Head and Neck Surgery, Brescia, Italy Background: Outcomes of locally advanced epithelial sinonasal cancer remain unsatisfactory, despite the improvement in surgical approaches and advances in radiotherapy techniques. The incorporation of induction chemotherapy (IC) in the multimodal treatment strategy has shown promising results in few studies. Only limited and heterogeneous data exist on prognostic factors, due to the rarity of this disease. Material and Methods: We reviewed consecutive patients (pts) with AJCC stage III-IV epithelial non glandular sinonasal cancer, treated at National Cancer Institute of Milan with IC followed by locoregional treatment, since 1996 to 2013. Overall survival (OS) and disease free survival (DFS) were calculated with Kaplan Meier method. The log rank test and Cox multivariate regression analysis were used to build a prognostic model for outcome according to clinical and pathological variables. Results: We identified 63 pts, whose clinical and treatment characteristics are reported in the table. IC was platinum based, associated with 5FU and lederfolin or 5FU and docetaxel. Cisplatin and etoposide alternating with ifosfamide and doxorubicin was employed for neuroendocrine cancer. Number of pts (%) Histology Sinonasal undifferentiated carcinoma − SNUC 25 Squamous cell carcinoma − SCC 24 Pure neuroendocrine cancer − SNEC 8 Small cell carcinoma − SmCC 6 Any neuroendocrine differentiation Yes 18 No 45 Stage III 13 IV 50 Response to IC Complete response 8 Partial response 45 Stable disease 7 Progressive disease 3 Treatment strategy after IC Surgery +/− radio(chemo)therapy 27 Chemoradiation 36

40 38 13 9 29 71 21 79 13 71 11 5 43 57

Globally, 34 pts experienced a recurrence (28 at locoregional level and 6 at distant sites); 14 pts received salvage surgery (12 on primary tumor and 2 on neck nodes), but only 2 of them remained free of disease (1 salvaged on T and 1 on N level). With a median follow up of 45 months,

5-year OS and DFS was 58% and 40% respectively. Only response to IC retained a prognostic value for OS (p = 0.0017), while the presence of any tumoral neuroendocrine differentiation showed a marginally significant worse outcome (p = 0.077). Conclusion: The prognosis of locally advanced epithelial sinonasal cancer remains unsatisfactory. Response to induction chemotherapy was the most important prognostic factor. More efforts should be spent to develop strategies overcoming tumor resistance. Two phase II trials are ongoing to investigate the role of IC in these tumors (Clinicaltrials.gov identifier: NCT02099175 and NCT02099188) No conflict of interest. 2828 POSTER Towards predicting tumour response in patients with locally advanced head and neck cancer treated with neoadjuvant chemotherapy T. Schuler1 , K. Nahar2 , D. Chan2 , M. Stevens1 , G. Schembri3 , A. Guminski2 , T. Eade1 . 1 Northern Sydney Cancer Centre, Radiation Oncology, St Leonards, Australia; 2 Northern Sydney Cancer Centre, Medical Oncology, St Leonards, Australia; 3 Royal North Shore Hospital, Nuclear Medicine, St Leonards, Australia Background: Neoadjuvant chemotherapy (NC) followed by chemoradiotherapy (CRT) is a growing paradigm in locally advanced head and neck squamous cell carcinoma (LAHNSCC). Response to NC is thought to be a predictor for local control. Materials and Methods: LAHNSCC patients treated between March 2010 and December 2014 with curative intent at our centre were eligible. Prior to NC all patients were staged with FDG-PET at baseline and then after 2 cycles of NC. A third cycle was delivered before commencing CRT. Radiation was delivered with IMRT to a dose of 70Gy in 35 fractions to gross residual disease, with lower doses to clinically at risk areas. Concurrent chemotherapy was scheduled with weekly cisplatin. The primary endpoint was volumetric response measured by the FDGPET/CT after 2 cycles of NC. Secondary endpoints were qualitative FDGPET response, overall survival (OS), metastatic free survival (MFS) and local regional (LR) control. Results: 19 patients were included (16 male, 3 female, median age 58, range 47−77). Primary sites were oropharynx (OP; n = 15), oral cavity (OC, n = 2), larynx (LA; n = 1) and hypopharynx (HP; n = 1) with all patients having associated nodal disease. Of the 15 OP patients, 12 were p16 positive. The NC regimen was cisplatin, fluorouracil and docetaxel (TPF) in all but 2 cases where cisplatin was replaced by carboplatin. Except for 1 patient (1 cycle) all patients received the full 3 cycles of NC. Complete FDG-PET response at 2 cycles was seen in 3 patients (2 OP, 1 HP; all p16 positive), a partial response in 15 patients and progression in 1 patient. The median reduction in gross tumour was 89.6% (−9.1% to 100%). In the p16 positive OP patients the median reduction was 85.6% versus 57.5% in the HPV negative patients. After a median follow up of 20 months (7 to 60 months) 2 patients were deceased (OS=89.5%), 2 patients developed metastatic disease at 7 and 41 months, and LR failure was 26.3% with 5 patients having developed LR recurrence. For this cohort, no significant correlation was found between gross tumour reduction and LR control or MFS. The low-risk subgroup (OP, p16+) had significantly superior LR control compared to the remaining higher-risk subgroup (median time to LR failure 32.5 months vs 15.1 months, p = 0.04) Conclusions: While a high OS at 89.5% was achieved, the FDG-PET/CT based volumetric measures were not predictive for LR control. The clinical low-risk subgroup had superior LR outcomes compared to the high-risk subgroup. Other indices of response such as SUVmax deserve further investigation. No conflict of interest.