355 poster Robotic stereotactic radiotherapy (CyberKnife) for head and neck cancer-results of 17 patients

s95

Posters

354

356

poster

The role of nasopharyngeal J. Conyi,

induction cancer

D. Rischit?,

chemotherapy

in

locally

advanced

L. Peters’

‘Peter MacCallum Cancer Mebourne, Australia

Institute,

Division

of Radiation

Oncology,

East

355

poster

K.1,

radiotherapy of 17 patients.

T. Fukuda*,

Y. lmate3,

M. Arigal,

A. Hiyama’,

Y. Karino’,

N. Teravama’, H. Kawashima’,

2Peter MacCallum Cancer Institute, Division of Haematology & Medical Oncology, East Melbourne, Australia Introduction: The role of induction chemotherapy in the management of locally advanced nasopharyngeal cancer (NPC) is unclear. Reduction in tumour bulk juxtaposed to vital dose-limiting structures, prior to definitive concurrent radiation therapy and chemotherapy, could be one possible major benefit. Methods: To investigate this possibility we reviewed 13 cases of T3 and T4 NPC (UICC 5th Ed) treated between Dee 1995 and Jan 1999 on our then current Phase II protocol. All the patients had had a pre-treatment MRI, a post induction chemotherapy MRI prior to commencement of radiation therapy (RT) with concurrent cisplatin, and a post chemo-radiotherapy MRI. Results: There were 9 males, 4 females, with a median age 47 years (2057yrs). Histologic subtype: WHO 3 - 11, WHO 2 - 2. Eight patients had T3; 5 had T4 turnours. Median follow-up was 2.8 years (1 .O - 4.3). All had 3 cycles of induction chemotherapy (epirubicin, cisplatin) at 3 weekly intervals, with continuous infusion 5-flurouracil, followed by radiation therapy with concurrent cisplatin in weeks 1 and 6. The specified radiation dose was 60Gy in 2Gy fractions to the primary and involved nodes with the constraint that the dose to the optic nerve/chiasm and brainstem did not exceed 54Gy. The overall response rate after all treatment was completed was 12/13 complete response (CR 92%) and 1 PR in the primary, and 13/13 CR in the nodes (100%). The response in the primary site after induction chemotherapy, but before concurrent chemo-RT, was 2 CR, 11 PR. Conclusion: Although planning target volumes were not reduced on the basis of chemotherapy-induced response, the major tumour bulk reduction observed in all patients increases the probability that gross residual disease received the full prescribed dose. The very high local CR rate achieved constitutes a justification for continued use of induction chemotherapy, ,in addition to concurrent chemotherapy, in locally advanced NPC.

Robotic stereotactic neck cancer-results

poster

CT arteriography chemotherapy firm the feeding

(CyberKnife)

K. Saitod,

for

K, Hori4,

head

and

K. Tsukamoto’,

N. Matsunaga’

’ Yamaguchi

University

School

of Medicine,

*Yamaguchi Ube, Japan

University

School of Medicine,

3Yamaguchi

University

School

of Medicine,

Radiology,

Oral and Maxillofacial Otolaryngology,

Surgery,

Ube, Japan

4Konan St. Hill Hospital CyberKnife Center, Ube, Japan Purpose: We report clinical results of the first 17 patients with head and neck cancer who received CyberKnife treatments since June 1999. Methods: The CyberKnife (Accuray, USA) is an image-guided robotic system designed for stereotactic radiotherapy composed of a 6 MV Linac with a robot gantry, a tracking system, a treatment planning system, and a computer workstation which integrated all components. Between June 1999 and May 2000, 17 patients (12 men, 5 women) underwent SRT. The ages ranged from 1 to 96 years old. There were 7 patients with oral cancer, 5 with pharyngeal cancer, 2 with parotid cancer, and 3 with other cancer. Postoperative irradiation was performed in 3 patients as adjunctive treatment. A number of visible targets was 17. Prescribed doses including 90% target volume ranging from 10 Gy to 31.7 Gy were delivered in I-5 fractions. Six patients with oral cancer had dental splints which provided spatial distances between normal tissue and the target. Results: Partial responses and complete remissions were observed in 10 patients and in 3 patients,respectively. There were no recurrences in 3 patients with postoperative irradiation. Primary response rate in 17 visible targets was 88%. Mucosal reactions were the major acute toxicity and responded well to conservative management. Four patients died of progressive disease. Conclusion: We reported recent results of CyberKnife therapy for head and neck cancer. Primary response rate was quite high. We feel this system is oowerful for cancer treatment.

in superselective arterial head and neck cancer: Useful artery and drug distribution.

J. Sanada’,

T. Takanakal,

T. Gabata’,

1Kanaza wa University,

H. Nishijima’,

M. Kadoya’,

Radiology,

0. Matsui’,

Kanazawa,

tool

infusion to con-

S. Kobayashi’, M. Furukawa*

Japan

*Kanazawa University, Otorhinolaryngology, Kanazawa, Japan Purpose: Superselective intraarterial infusion chemotherapy has been attempted for patients with head and neck cancer to obtain a greater therapeutic effect. The purpose of this study was to assess the efficacy of CT arteriography (CTA) to confirm the feeding artery and the distribution of anticancer agents. Methods: Thirty-seven patients with head and neck cancer (nasophatynx 7, oropharynx 4, hypopharynx 9, larynx 9, tongue 3 and others 5) underwent angiography 91 times for intraarterial infusion chemotherapy. Superselective catheterization was performed with a coaxial catheter system with a 5F-guiding catheter and a 2.7F-microcatheter. After the microcatheter was inserted into the target artery, digital subtraction angiography (DSA) and CTA were performed with an IVR-CTiAngio system, which is the DSA system equipped with a CT scanner. Confirming the feeding arteries of the tumor, cisplatin or carboplatin, and pirarubicin hydrochloride were injected at a rate of 5mg/min. Concurrent radiotherapy was also performed. Results: Of 88 times of angiography in 35 patients, the accurate feeding arteries of the tumor were confirmed and superselective intraarterial infusion chemotherapy was successful. It was also confirmed that the selected arterial branches supplied the entire tumor. In a case of primary laryngeal carcinoma, a case of nasopharyngeal carcinoma, and a case of laryngeal carcinoma with recurrence in lymph nodes, the feeding arteries could not be identified and the superselective intraarterial infusion chemotherapy was abandoned. If CTA showed inappropriate distribution of the drug, another arterial branch was catheterized and CTA was repeated. Conclusion: CTA made it possible to confirm the accurate feeding arteries of the tumor and the distribution of the drug even in the deep cervical region. Furthermore, CTA was easily repeated with the IVR-CT/Angie system, if the selected arterial branches were inappropriate. CTA in superselective arterial infusion chemotherapy for head and neck cancer is considered to be a useful tool. 357

poster

Cholinesterase neck cancer

and treated

E.M. Hobiaerl,

R. Willminge?,

rHospital Ube, Japan

for

of Vienna-Lainz,

Haemoglobin by combined

as predictors modalities

M. Eggerl,

Department

in head

and

W. Dobrowsky’

for Radiotherapy,

Vienna, Austria

*Hospital of Vienna-Lainz, Department for Head and Neck Surgery, Vienna, Austria Purpose:Patients with advanced head and neck cancers treated with combined radiochemotherapy between 1991 and 1998 were retrospectively analysed regarding predictive factors for response and survival. Patients and methods: A total of 151 patients aged 56 years (median) underwent treatment. Most patients had stage T3-4 tumours and lymph node metastases. Sites of tumour origin was: epipharynx 4, hypopharynx 48, larynx 25, oral cavity 49 and oropharynx 25, respectively. Histology was squamous cell cancer in all cases, Treatment consisted of accelerated fractionation radiotherapy: I,8 Gy bid in two daily fractions, to a total dose of 70,2 Gy in 7 weeks (a 10 days split was performed after 23,4 Gy and 46,8 Gy). Chemotherapy was administered over 5 days three times (starting days 1, 21 and 42): 60 mg/sqm CDDP on day 1, 21 and 42, 350 mg/sqm/24 h 5-FU on days 1-5, 21-25 and 42-46 and 100 mg/sqm LV on days 1-5, 21-25 and 42-46. Results: The overall rate of initial complete response (CR) was 64 % and was depending on tumour stage, site and pretherapeutic Hb level of patient. Crude and actuarial survival were dependent on site, stage of disease as well as of pretherapeutic Hb level. Overall crude survival was 38 % after 35 months median follow-up.ln cases who showed CR the median Hb was 14,i g/dl compared to 13,7 g/dl in non-CR. Actuarial survival was significantly increased for patients who had a pretherapeutic Hb level higher than mean. In 48 cases serum cholinesterase was determined prior and during therapy. The mean value was 4789 U/I, for those who achieved CR mean value was 5483 U/I vs. 3729 U/I in non-CR (PcO,OOO7). Actuarial survival was statistically significant (pcO,OOOOl) better in patients who had a higher than mean value of cholinesterase prior to therapy. Conclusion:Pretherapeutic Hb-level and serum cholinesterase level are