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328 poster Late morbidity of concomitant chemotherapy and accelerated fractionation radiotherapy in locally advanced unresectable head and neck cancer
Posters
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nant invading the ranges. (2)Through the conformal portals were accurately designed, the irradiation target volume would be designed more rational, and the near important organs can be shielded effectively. 328
poster
Late morbidity of concomitant chemotherapy and accelerated fractionation radiotherapy in locally advanced unresectable head and neck cancer J. Draqovic 1, 7-. Doyle 2, R. Nichols3, G. Jacobsen 4 1Henry Ford Hospital, Radiation Oncology, Detroit, USA 2Henry Ford Hospital, Medical Oncology, Detroit, USA 3Henry Ford Hospital, Otolaryngology, Detroit, USA 4Henry Ford Hospital, Biostatistics, Detroit, USA Purpose: To evaluate Iongterm results of concomitant chemo/radiotherapy (CT/RT)in terms of late treatment morbidity, quality of life, tumor control and factors predictive of Iongterm tumor control and survival. Methods: A cohort of 34 patients with stage IV unresectable head and neck cancer were treated with concomitant CT/RT on weeks 1,3 and 5,consisting of accelerated twice-a-day RT (2 Gy bid,>6hours apart;total dose 70 Gy) concurrently with cisplatin (day 1) and continuous infusion of 5FU (days 1-5). Complete responders who survived beyond 5 years were evaluated for late morbidity. Quality of life questionaire was applied. Factors predictive of Iongterm survival were sought and identified. Results: Complete response t o treatment was 82%. Thirteen patients (38%) survived beyond 5 years without evidence of local or distant failure. Longterm survivors tended to be younger (median age 53 v. 61), have better performance status (ECOG O) and primaries in the oropharynx and paranasal sinuses. Significant late complications developed in 4 patients (oro-antral fistula, fracture of mandible, soft tissue necrosis of oropharynx, neck fibrosis resulting in bilateral hypoglassal nerve palsy). An additional patient required multiple odentectomies due to severe caries. Eight patients are living completely normal productive lives, free of cancer and significant late morbidity. Conclusions: Concomitant CT/RT is an aggressive treatment regimen associated with high response rate and remarkable disease-free survival. This success is offset by the impact on quality of life and a 30% late morbidity, urging further refinements to achieve the ultimate therapeutic goal improved tumor control without increased Iongterm morbidity. 329
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Preoperative radiotherapy with concurrent paclitaxel and carboplatin in stage Ill/IV cancer of the oropharynx/oral cavity: 2-year results of a phase II study D. Rades 1, I. Wildfang 1, A. Eckardt 2, C. Kuettner 2-, R. Dammer 3, C. Hofele 4, J.H. Karstens 1 1Hannover Medical University, Radiation Oncology, Hannover, Germany 2Hannover Medical University, Oral and Maxillofacial Surgery, Hannover, Germany 3Regensburg University Clinic, Oral and Maxillofacial Surgery, Regensburg, Germany 4Heidelberg University Clinic, Iral and Maxillofacial Sugery, Heidelberg, Germany Introduction: Based on documented excellent radiosensitization effects, a prospective phase !l-study was in!tiated using a preoperative regimen with paclitaxel and carboplatin in combination with radiotherapy (conventional fractionation), followed by surgery of the primary tumor and regional neck nodes. Methods: From 5/98 to 4/00 thirty-nine patients were included. Total radiation dose was 40.0 Gy (5 x 2.0 Gy/week), treatment volume included the primary tumor and regional lymph nodes. Concurrent chemotherapy consisted of a weekly application of paclitaxel (40 mg/m 2) and carboplatin (AUC 1,5), 5 cycles in total. Surgery was performed 3-4 weeks after completion of radiochemotherapy. Results: Patient characteristics: females 6, males 33; median age 54 (3175) years; tumor stage: III 10, IV 29; tumor site: oral cavity 30, oropharynx 9.38 patients were evaluabie for toxicity and response, median follow-up 10 (5-20) months. All of these 38 patients developed a mucositis grade 23 (CTC), 29% a dermatitis grade 2, 6% a dermatitis grade 3. Hematologic toxicity (CTC) was as follows: anemia grade 3 15%; leukopenia grade 3 35%, grade 4 9%; thrombopenia grade 3 15%. One treatment related death occurred due to septic neutropenia. Clinical response rates were 53% cCR (20/38) and 47% cPR (18/38). Surgery was performed in 37/39 patients (1 early death, 1 definitive radiotherapy). 32 patients (82%) were evaluable for pathologic response with 50% pCR (16/32) and 50% pPR
(16/32). Conclusions: Concurrent radiotherapy with paclitaxel and carboplatin resulted in excellent clinical and pathological response rates in patients with advanced cancer of the oropharynx/oral cavity. Due to hematologic toxicity a close monitoring of the patients is required. This phase II trial will be followed by a randomized study. 330
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Nasopharyngeal carcinoma: a clinical study of parapharyngeal space interstitial brachytherapy combined with external radiotherapy J.J. Pan., J.X. Wu, M. Chen, C.B. Chen Fujian tumor hospital, radiotherapy department, Fuzhou, China Purpose: To evaluate the role of parapharyngeal space interstitial brachytherapy (PSIB) in the treatment of primary nasopharyngeal carcinoma (NPC). Methods The authors developed a new brachytherapy technique of NPC in April 1996, under the guidance of simulator fluoroscopy, catheters were inserted from submaxillary region into the parapharyngeal space. It is specially useful in the treatment of NPC with involvement of parapharynx. From April 1996 to jun e t998, 67 cases of NPC of T2 and T3 stage who had parapharyngeal space residual on CT or MRI slices following 56-70Gy of externa! radiotherapy :received PSIB, 1-4 catheters were inserted to parapharynx, then they were treated by Ir-192 high dose rate afterloading unit to a total dose of 12-20Gy/6-8fractions/3-4days. A control group of 67 cases was formed by the similar patients of the same time, they received external radiotherapy alone to a total dose of 70-83Gy. Results: During and after PSIB, no serious complication occurred in the PSIB group, the 3-year overall survival rates were 92.44% and 84.54% for the PSIB group aqd control group, respectively (p>0.05); the 3-year free from distant metastasis survival rates were 76.58% and 69.13% for the PSIB group and control group, respectively (p>0.05). the 3-year free from local relapse survival rate of the PSIB group was significantly higher than that of the control group (96.97%:76.36%, P<0.O5), and the late radiation sequelae incidence was lower than the control group. Conclusions: Parapharyngeal space interstitial brachytherapy could significantly improve the local control of primary NPC with parapharyngeal space involvement, and thus widen the range of indication of brachytherapy in the treatment of NPC, it is a safe and effective method of boosting to external radiotherapy of NPC. 331
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Does the "Will Rogers Phenomenon" apply in supraglottic laryngeal carcinoma when a new staging system is applied? R. Smee 1, G.P. Bridger2, J. Williams 1 I prince of Wales Hospital, Radiation Oncology, Sydney, Australia 2prince of Wales Hospital, Otolaryngology, Sydney, Australia Introduction: "Stage Shift" involves redistributing patients from one subgroup to another without influencing the treatment results for the overall group. The aim of this review is for a single centre to document the impact of the 1988 UICC revised staging methods for supraglottic laryngeal carcinoma on outcomes, both local control and overall survival. Materials and Methods: The 1998 UICC revision for T stage changed the emphasis for upstaging from contiguous spread to that of fixation, with N designation unchanged. For the 319 patients in this retrospectively reviewed series T1 remained unchanged between old T and new T with 56 patients (16%). Respective T staging for old and new classification is thus T2 67 (21%) and 129 (40%), T3 t 12 (35%) and 90 (28%), and T4 72 (23%) and 42 (13%) with 13 patients being unstageable by T category. Treatment delivered was classified as surgery only, radiotherapy only, surgery and post operative radiotherapy, and pro/operative radiotherapy and surgery. Results: For those patien!s having surgery only the local failure rates old and new T respectively were: T1 0/4 and 0/4, T2 0/4 and 1/6, T3 0/9 and 0/I0 and T4 1/2 and 0/1. For radiotherapy only the local failure rates for old and new T were: T1 12/50 (24%) and 12/50 (24%), T2 15/46 (33%) and 32/81 (40%), T3 26/51 (51%) and 18/31 (58%), and T4 19/38 (50%) and 10/23 (43%). For surgery and post operative radiotherapy the results were respectively T1 0/1 and 0/1, T2 1/12 (8%) and 1/26 (4%), T3 2/51 (3%) and 4/50 (8%) and T4 3/30 (10%) and 1/17 (6%). The figures for pre operative radiotherapy were unchanged between old and new T. None of these figures are significantly different between the old and new T, for any treatment modality in respect of local control. In fact the same applies for overall survival. Conclusion: The biggest impact of the T stage revisions for supraglottic laryngeal cancer is to transfer a number of patients from T3 and T4 to T2.
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nant invading the ranges. (2)Through the conformal portals were accurately designed, the irradiation target volume would be designed more rational, and the near important organs can be shielded effectively. 328
poster
Late morbidity of concomitant chemotherapy and accelerated fractionation radiotherapy in locally advanced unresectable head and neck cancer J. Draqovic 1, 7-. Doyle 2, R. Nichols3, G. Jacobsen 4 1Henry Ford Hospital, Radiation Oncology, Detroit, USA 2Henry Ford Hospital, Medical Oncology, Detroit, USA 3Henry Ford Hospital, Otolaryngology, Detroit, USA 4Henry Ford Hospital, Biostatistics, Detroit, USA Purpose: To evaluate Iongterm results of concomitant chemo/radiotherapy (CT/RT)in terms of late treatment morbidity, quality of life, tumor control and factors predictive of Iongterm tumor control and survival. Methods: A cohort of 34 patients with stage IV unresectable head and neck cancer were treated with concomitant CT/RT on weeks 1,3 and 5,consisting of accelerated twice-a-day RT (2 Gy bid,>6hours apart;total dose 70 Gy) concurrently with cisplatin (day 1) and continuous infusion of 5FU (days 1-5). Complete responders who survived beyond 5 years were evaluated for late morbidity. Quality of life questionaire was applied. Factors predictive of Iongterm survival were sought and identified. Results: Complete response t o treatment was 82%. Thirteen patients (38%) survived beyond 5 years without evidence of local or distant failure. Longterm survivors tended to be younger (median age 53 v. 61), have better performance status (ECOG O) and primaries in the oropharynx and paranasal sinuses. Significant late complications developed in 4 patients (oro-antral fistula, fracture of mandible, soft tissue necrosis of oropharynx, neck fibrosis resulting in bilateral hypoglassal nerve palsy). An additional patient required multiple odentectomies due to severe caries. Eight patients are living completely normal productive lives, free of cancer and significant late morbidity. Conclusions: Concomitant CT/RT is an aggressive treatment regimen associated with high response rate and remarkable disease-free survival. This success is offset by the impact on quality of life and a 30% late morbidity, urging further refinements to achieve the ultimate therapeutic goal improved tumor control without increased Iongterm morbidity. 329
poster
Preoperative radiotherapy with concurrent paclitaxel and carboplatin in stage Ill/IV cancer of the oropharynx/oral cavity: 2-year results of a phase II study D. Rades 1, I. Wildfang 1, A. Eckardt 2, C. Kuettner 2-, R. Dammer 3, C. Hofele 4, J.H. Karstens 1 1Hannover Medical University, Radiation Oncology, Hannover, Germany 2Hannover Medical University, Oral and Maxillofacial Surgery, Hannover, Germany 3Regensburg University Clinic, Oral and Maxillofacial Surgery, Regensburg, Germany 4Heidelberg University Clinic, Iral and Maxillofacial Sugery, Heidelberg, Germany Introduction: Based on documented excellent radiosensitization effects, a prospective phase !l-study was in!tiated using a preoperative regimen with paclitaxel and carboplatin in combination with radiotherapy (conventional fractionation), followed by surgery of the primary tumor and regional neck nodes. Methods: From 5/98 to 4/00 thirty-nine patients were included. Total radiation dose was 40.0 Gy (5 x 2.0 Gy/week), treatment volume included the primary tumor and regional lymph nodes. Concurrent chemotherapy consisted of a weekly application of paclitaxel (40 mg/m 2) and carboplatin (AUC 1,5), 5 cycles in total. Surgery was performed 3-4 weeks after completion of radiochemotherapy. Results: Patient characteristics: females 6, males 33; median age 54 (3175) years; tumor stage: III 10, IV 29; tumor site: oral cavity 30, oropharynx 9.38 patients were evaluabie for toxicity and response, median follow-up 10 (5-20) months. All of these 38 patients developed a mucositis grade 23 (CTC), 29% a dermatitis grade 2, 6% a dermatitis grade 3. Hematologic toxicity (CTC) was as follows: anemia grade 3 15%; leukopenia grade 3 35%, grade 4 9%; thrombopenia grade 3 15%. One treatment related death occurred due to septic neutropenia. Clinical response rates were 53% cCR (20/38) and 47% cPR (18/38). Surgery was performed in 37/39 patients (1 early death, 1 definitive radiotherapy). 32 patients (82%) were evaluable for pathologic response with 50% pCR (16/32) and 50% pPR
(16/32). Conclusions: Concurrent radiotherapy with paclitaxel and carboplatin resulted in excellent clinical and pathological response rates in patients with advanced cancer of the oropharynx/oral cavity. Due to hematologic toxicity a close monitoring of the patients is required. This phase II trial will be followed by a randomized study. 330
poster
Nasopharyngeal carcinoma: a clinical study of parapharyngeal space interstitial brachytherapy combined with external radiotherapy J.J. Pan., J.X. Wu, M. Chen, C.B. Chen Fujian tumor hospital, radiotherapy department, Fuzhou, China Purpose: To evaluate the role of parapharyngeal space interstitial brachytherapy (PSIB) in the treatment of primary nasopharyngeal carcinoma (NPC). Methods The authors developed a new brachytherapy technique of NPC in April 1996, under the guidance of simulator fluoroscopy, catheters were inserted from submaxillary region into the parapharyngeal space. It is specially useful in the treatment of NPC with involvement of parapharynx. From April 1996 to jun e t998, 67 cases of NPC of T2 and T3 stage who had parapharyngeal space residual on CT or MRI slices following 56-70Gy of externa! radiotherapy :received PSIB, 1-4 catheters were inserted to parapharynx, then they were treated by Ir-192 high dose rate afterloading unit to a total dose of 12-20Gy/6-8fractions/3-4days. A control group of 67 cases was formed by the similar patients of the same time, they received external radiotherapy alone to a total dose of 70-83Gy. Results: During and after PSIB, no serious complication occurred in the PSIB group, the 3-year overall survival rates were 92.44% and 84.54% for the PSIB group aqd control group, respectively (p>0.05); the 3-year free from distant metastasis survival rates were 76.58% and 69.13% for the PSIB group and control group, respectively (p>0.05). the 3-year free from local relapse survival rate of the PSIB group was significantly higher than that of the control group (96.97%:76.36%, P<0.O5), and the late radiation sequelae incidence was lower than the control group. Conclusions: Parapharyngeal space interstitial brachytherapy could significantly improve the local control of primary NPC with parapharyngeal space involvement, and thus widen the range of indication of brachytherapy in the treatment of NPC, it is a safe and effective method of boosting to external radiotherapy of NPC. 331
poster
Does the "Will Rogers Phenomenon" apply in supraglottic laryngeal carcinoma when a new staging system is applied? R. Smee 1, G.P. Bridger2, J. Williams 1 I prince of Wales Hospital, Radiation Oncology, Sydney, Australia 2prince of Wales Hospital, Otolaryngology, Sydney, Australia Introduction: "Stage Shift" involves redistributing patients from one subgroup to another without influencing the treatment results for the overall group. The aim of this review is for a single centre to document the impact of the 1988 UICC revised staging methods for supraglottic laryngeal carcinoma on outcomes, both local control and overall survival. Materials and Methods: The 1998 UICC revision for T stage changed the emphasis for upstaging from contiguous spread to that of fixation, with N designation unchanged. For the 319 patients in this retrospectively reviewed series T1 remained unchanged between old T and new T with 56 patients (16%). Respective T staging for old and new classification is thus T2 67 (21%) and 129 (40%), T3 t 12 (35%) and 90 (28%), and T4 72 (23%) and 42 (13%) with 13 patients being unstageable by T category. Treatment delivered was classified as surgery only, radiotherapy only, surgery and post operative radiotherapy, and pro/operative radiotherapy and surgery. Results: For those patien!s having surgery only the local failure rates old and new T respectively were: T1 0/4 and 0/4, T2 0/4 and 1/6, T3 0/9 and 0/I0 and T4 1/2 and 0/1. For radiotherapy only the local failure rates for old and new T were: T1 12/50 (24%) and 12/50 (24%), T2 15/46 (33%) and 32/81 (40%), T3 26/51 (51%) and 18/31 (58%), and T4 19/38 (50%) and 10/23 (43%). For surgery and post operative radiotherapy the results were respectively T1 0/1 and 0/1, T2 1/12 (8%) and 1/26 (4%), T3 2/51 (3%) and 4/50 (8%) and T4 3/30 (10%) and 1/17 (6%). The figures for pre operative radiotherapy were unchanged between old and new T. None of these figures are significantly different between the old and new T, for any treatment modality in respect of local control. In fact the same applies for overall survival. Conclusion: The biggest impact of the T stage revisions for supraglottic laryngeal cancer is to transfer a number of patients from T3 and T4 to T2.