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2845 Treatment of xerostomia induced radiotherapy in patients with the head and neck cancer - Preliminary study
S572 2843 POSTER 3D-image based high-dose-rate interstitial brachytherapy as monotherapy for lower lip cancer: A preliminary study H. Akiyama1 , T. Kotsuma2 , K. Yoshida3 , K. Masui4 , H. Yamazaki4 , M. Mikami Ueda5 , T. Takenaka6 , T. Arika7 , E. Tanaka2 , S. Gamoh1 , K. Shimizutani1 . 1 Osaka Dental University, Department of Oral Radiology, Osaka, Japan; 2 National Hospital Organization Osaka National Hospital, Department of Radiation Oncology, Osaka, Japan; 3 Osaka Medical college, Department of Radiation Oncology, Takatsuki, Japan; 4 Kyoto Prefectural University of Medicine, Department of Radiology, Kyoto, Japan; 5 National Hospital Organization Osaka National Hospital, Department of Radiology, Osaka, Japan; 6 National Hospital Organization Himeji Medical Center, Department of Radiology, Himeji, Japan; 7 National Hospital Organization Osaka National Hospital, Department of Oral Surgery, Osaka, Japan Background: Recently, as CT and MRI become common in medical practice, 3D-image based high-dose-rate interstitial brachytherapy (HDRISBT) has been used to visualize gross tumor volume (GTV) and clinical target volume (CTV), and to prescribe optimamu dose. In this study, we present our preliminary results for lower lip cancer treated by 3D-image based HDR-ISBT. Material and Methods: Between January 2012 and January 2015, 6 patients (male:female=3:3) with localized lower lip cancer were treated with 3D-image based HDR-ISBT. Five patients were previously untreated and 1 was a recurrent case with a history of irradiation. All the tumors were histologically identified as squamous cell carcinoma. The median patients’ age was 79.5 years (range; 46−95 years), median follow-up time was 18 months (range; 2−36 months). Concerning tumor size, 3, 2, and 1 patients were classified as T1, T2, and T3, respectively. One to 3 plastic applicators were implanted through the lip region. We also placed 2−6 applicators on the tumor surface using original template to avoid dose shortage due to the edema during treatment period. For 3D-image based planning, after CT (all cases) and MRI (2 cases) were performed, GTV, mandible, and applicators were delineated using brachytherapy planning system. CTV was defined as GTV plus 5 mm for previously untreated patients, which was equivalent to GTV for recurrent patient. Five previously untreated lesions were treated with HDR-ISBT to 54 Gy, and 1 recurrent lesion to 48 Gy, being 6 Gy for the single fraction dose at CTV margin. A custom-made lead block or silicon spacer was inserted between gingiva and lower lip during ISBT to reduce the dose for mandible (except an edentulous case). Patient’s mouth was opened to reduce the dose for upper lip. To evaluate treatment quality, the volume of GTV and CTV, the dose that covered 90% and 100% of GTV and CTV (D90(GTV,CTV) and D100(GTV,CTV) ), and minimum dose received by the maximally irradiated 0.1 cc volume of the mandible (D0.1cc(mandible) ) were calculated by using Dose-Volume-Histogram. Results: The median volume of GTV and CTV were 2.4 cc (range; 0.14– 17.4 cc) and 4.1 cc (range; 1.4–25.4 cc). The median of D90(GTV), D100(GTV) , D90(CTV), D100(CTV) , and D0.1cc(mandible) were 7.1 Gy (range; 6.2−8.9 Gy), 6.3 Gy (range; 5.9−8.3 Gy), 6.8 Gy (range; 5.9−8.1 Gy), 5.6 Gy (range; 4.2−6.8 Gy), and 3.2 Gy (range; 1.5−4.1 Gy), respectively. D90(CTV) of all but one patients were covered by prescribed dose. All patients have been disease free without late adverse effect, such as skin and mandibular necrosis, so far. Conclusions: 3D-image based HDR-ISBT for lower lip cancer seems to be favorable because prescribed dose was administered to CTV accurately without applying excessive dose for mandible. All primary lesions have been controlled without late adverse effect. No conflict of interest. 2844 POSTER Patterns of neck recurrence after postoperative radiotherapy of tonsillar cancer: Analysis of Korean radiation oncology group 11−07 data N. Choi1 , C.G. Lee2 , Y.C. Ahn3 , D. Oh3 , S.W. Lee4 , H.G. Wu1 , S.H. Moon5 , Y.S. Kim6 , J.H. Kim1 . 1 Seoul National University College of Medicine, Radiation Oncology, Seoul, South Korea; 2 Yonsei University College of Medicine, Radiation Oncology, Seoul, South Korea; 3 Samsung Medical Center, Sungkyunkwan University School of Medicine, Radiation Oncology, Seoul, South Korea; 4 Asan Medical Center, University of Ulsan College of Medicine, Radiation Oncology, Seoul, South Korea; 5 Research Institute and Hospital, National Cancer Center, Radiation Oncology, Goyang, South Korea; 6 Seoul St. Mary’s Hospital, Catholic University of Korea College of Medicine, Radiation Oncology, Seoul, South Korea Background: To retrospectively analyze patterns of neck recurrence in tonsillar squamous cell carcinoma (SCC) after postoperative radiotherapy (PORT) in relation with neck metastasis and neck irradiation (NI). Materials and Methods: Medical records of 353 patients that underwent PORT at 15 institutions for histologically confirmed tonsillar SCC from 1993 to 2011 were retrospectively analyzed. Neck metastasis was absent (pN0)
Abstracts in 45 (12.7%) and present (pN+) in 309 (87.3%) patients: ipsilateral in 269 (76.2%) and bi- or contralateral in 39 (11.0%). Patients with bi- or contralateral neck metastasis were excluded from the final analysis. Results: After a median follow-up of 53 months, neck recurrence occurred in 19 (6.1%) patients. In pN0 patients (n = 45), NI was ipsilateral in 26 (57.8%) and bilateral in 19 (42.2%). After ipsilateral NI, 7.7% (2/26) failed in bi- or contralateral necks. No contralateral neck failure occurred after bilateral NI. In ipsilateral pN+ patients (n = 269), NI was ipsilateral in 67 (24.9%) and bilateral in 202 (75.1%). Neck recurrence in bi- or contralateral necks occurred in 4.5% (3/68) after ipsilateral NI and in 2.0% (4/202) after bilateral NI. In terms of neck recurrence, there was no significant difference between ipsilateral and bilateral NI for both pN0 and ipsilateral pN+ patients. Conclusions: Contralateral neck failures were unusual after ipsilateral NI in pN0 or ipsilateral pN+ patients. No conflict of interest. 2845 POSTER Treatment of xerostomia induced radiotherapy in patients with the head and neck cancer − Preliminary study A. Zygulska1 , A. Słowik1 , K. Konopka1 , A. Michałowska-Kaczmarczyk1 , K. Krzemieniecki2 . 1 University Hospital, Oncology Department, Krakow, Poland; 2 Jagiellonian University, Medical School, Krakow, Poland Background: The irradiation of the head and neck cancers causes xerostomia which seriously worsens the patients’ quality of life. The aim of this study was to evaluate and compare the efficacy of artificial saliva (maximum 16 tablets daily) from the first day of radiotherapy (as a prophylaxis) versus from the starting symptoms of xerostomia. Material and Methods: Twenty-five patients with head and neck cancer starting radical/adjuvant radiotherapy or chemoradiotherapy were randomly enrolled to this study from January 2012 to April 2015 in Oncological Department of University Hospital in Krakow, Poland. Patients received artificial saliva tablets from the first day of radiotherapy, in the second group − took tablets from xerostomia symptoms beginning. Efficacy of the treatment was on the basis of the questionnaire xerostomia symptoms escalation within radiotherapy (in the first day of radiotherapy, after 3 and 6 weeks) and after treatment completion (after 2 and 6 months). The data describing analyzed groups were characterized by median values (ordinal variables) and numbers of patients or other quantifiable data in each group by percentage values. Mann–Whitney test was performed to assess the difference of analysed parameters between two groups. In all statistical analyses, 95% confidence level was assumed and Statistica ver 12 was used. The study was approved by local medical ethics committee. Every patient signed informed consent. Patient characteristics are presented in tables 1. Results: Differences between analyzed groups were not statistically significant, except for the evaluation of limitation of the amount and kind of taking meals before radiotherapy. The graphs presents the dependance of the median effect and the time of evaluation after the therapy (drying of the oral mucosa, mouth pain, loss of taste, swallowing difficulty and cumulated survey data of individual assessment of patients well-being after 3 weeks, 6 weeks, 2 months and 6 months after the therapy). The graphs shows also the dependence of the number of patients and the score of effect after each time of evaluation and analyzed groups. Conclusions: Both groups found taking the medication as an effective, but relief of xerostomia symptoms was assessed to be more efficient in group B (taking tablets from the starting symptoms of xerostomia). No conflict of interest. 2846 POSTER Retrospective study of prophylactic neck irradiation of Head and Neck squamous cell carcinomas in the postoperative setting 1 A. Mat´ıas-Perez ´ , P. Soria-Carreras1 , M. Blanco-Villar1 , K. Matskov1 , C. Gil-Restrepo1 , O. Alonso-Rodr´ıguez1 , S. Rodr´ıguez-Garc´ıa1 , 1 1 C. Cigarral-Garc´ıa1 , V. Mac´ıas-Hernandez , L. Perez-Romasanta ´ , ´ 2 1 M. Sanchez-Barba ´ . Complejo Asistencial Universitario de Salamanca, ´ Servicio Oncolog´ıa Radioterapica, Salamanca, Spain; 2 Universidad de Salamanca, Department of Statistics, Salamanca, Spain
Background: Head and Neck squamous cell carcinomas includes a large group of cancers. Many patients are primarily treated with surgery, followed by RT. Studies concerning the outcome of elective irradiation of the N0 neck are scarce. The main purpose of the current study was to describe the results of elective irradiation in cN0 necks in single institutional series.
Abstracts in 45 (12.7%) and present (pN+) in 309 (87.3%) patients: ipsilateral in 269 (76.2%) and bi- or contralateral in 39 (11.0%). Patients with bi- or contralateral neck metastasis were excluded from the final analysis. Results: After a median follow-up of 53 months, neck recurrence occurred in 19 (6.1%) patients. In pN0 patients (n = 45), NI was ipsilateral in 26 (57.8%) and bilateral in 19 (42.2%). After ipsilateral NI, 7.7% (2/26) failed in bi- or contralateral necks. No contralateral neck failure occurred after bilateral NI. In ipsilateral pN+ patients (n = 269), NI was ipsilateral in 67 (24.9%) and bilateral in 202 (75.1%). Neck recurrence in bi- or contralateral necks occurred in 4.5% (3/68) after ipsilateral NI and in 2.0% (4/202) after bilateral NI. In terms of neck recurrence, there was no significant difference between ipsilateral and bilateral NI for both pN0 and ipsilateral pN+ patients. Conclusions: Contralateral neck failures were unusual after ipsilateral NI in pN0 or ipsilateral pN+ patients. No conflict of interest. 2845 POSTER Treatment of xerostomia induced radiotherapy in patients with the head and neck cancer − Preliminary study A. Zygulska1 , A. Słowik1 , K. Konopka1 , A. Michałowska-Kaczmarczyk1 , K. Krzemieniecki2 . 1 University Hospital, Oncology Department, Krakow, Poland; 2 Jagiellonian University, Medical School, Krakow, Poland Background: The irradiation of the head and neck cancers causes xerostomia which seriously worsens the patients’ quality of life. The aim of this study was to evaluate and compare the efficacy of artificial saliva (maximum 16 tablets daily) from the first day of radiotherapy (as a prophylaxis) versus from the starting symptoms of xerostomia. Material and Methods: Twenty-five patients with head and neck cancer starting radical/adjuvant radiotherapy or chemoradiotherapy were randomly enrolled to this study from January 2012 to April 2015 in Oncological Department of University Hospital in Krakow, Poland. Patients received artificial saliva tablets from the first day of radiotherapy, in the second group − took tablets from xerostomia symptoms beginning. Efficacy of the treatment was on the basis of the questionnaire xerostomia symptoms escalation within radiotherapy (in the first day of radiotherapy, after 3 and 6 weeks) and after treatment completion (after 2 and 6 months). The data describing analyzed groups were characterized by median values (ordinal variables) and numbers of patients or other quantifiable data in each group by percentage values. Mann–Whitney test was performed to assess the difference of analysed parameters between two groups. In all statistical analyses, 95% confidence level was assumed and Statistica ver 12 was used. The study was approved by local medical ethics committee. Every patient signed informed consent. Patient characteristics are presented in tables 1. Results: Differences between analyzed groups were not statistically significant, except for the evaluation of limitation of the amount and kind of taking meals before radiotherapy. The graphs presents the dependance of the median effect and the time of evaluation after the therapy (drying of the oral mucosa, mouth pain, loss of taste, swallowing difficulty and cumulated survey data of individual assessment of patients well-being after 3 weeks, 6 weeks, 2 months and 6 months after the therapy). The graphs shows also the dependence of the number of patients and the score of effect after each time of evaluation and analyzed groups. Conclusions: Both groups found taking the medication as an effective, but relief of xerostomia symptoms was assessed to be more efficient in group B (taking tablets from the starting symptoms of xerostomia). No conflict of interest. 2846 POSTER Retrospective study of prophylactic neck irradiation of Head and Neck squamous cell carcinomas in the postoperative setting 1 A. Mat´ıas-Perez ´ , P. Soria-Carreras1 , M. Blanco-Villar1 , K. Matskov1 , C. Gil-Restrepo1 , O. Alonso-Rodr´ıguez1 , S. Rodr´ıguez-Garc´ıa1 , 1 1 C. Cigarral-Garc´ıa1 , V. Mac´ıas-Hernandez , L. Perez-Romasanta ´ , ´ 2 1 M. Sanchez-Barba ´ . Complejo Asistencial Universitario de Salamanca, ´ Servicio Oncolog´ıa Radioterapica, Salamanca, Spain; 2 Universidad de Salamanca, Department of Statistics, Salamanca, Spain
Background: Head and Neck squamous cell carcinomas includes a large group of cancers. Many patients are primarily treated with surgery, followed by RT. Studies concerning the outcome of elective irradiation of the N0 neck are scarce. The main purpose of the current study was to describe the results of elective irradiation in cN0 necks in single institutional series.