- Email: [email protected]
375Hyperfractionated radiotherapy (RT) in head and neck carcinoma with special reference to high dose preoperative treatment
$97 374 TREATMENT OROPHARYNX
375 R E S U L T S IN O R A L C A V I T Y A N D CARCINOMAS
Ataman O. Sen M. Akman F , Gorken I B. TuzcuotJluG. Gunen E A Gunbay U , Alanyall H , (~ehngozR, Kmay M ,Sutay S, Pabucrcuo~lluU , Ada E, CeP/-anK Dokuz EylUl Medical School Head and Neck Cancer Group IZMIRTURKIYE Oral cavity cancer represents many diseases Treatment of these turnouts depends on the Iocahsahon, extent and performance status of the pahent Surgery or radiation therapy ts the mainstay of treatment in early stages In advanced cases, combined modahty treatment ts preferred Etghty stx patmnts wdh oral cawty and oropharynx carcinomas were treated between July 1991 January 1996 and the results were analysed retrospectively They were 58 males and 28 females, at the mean age of 59 (32-83) One patient was stage 0 ( Tis NO ) , 10 pts were stage I ( T I N 0 ) , 7 pts were stage tl ( T2N0 ) . 20 pts were stage III ( T3N0 6, TIN1 2, T2N1 6. T3N1 6 ) . 33 pts were stage IV ( T2N2 1, T3N2 1, T4N0 7. T4N1 9 T4N2 14. T4N3 1 } Nine patients were treated after salvage surgery and thetr stages could not be assesed Seven pahents had local and / or regional relaps at their referrat Most of the pahents were eptdermo=d ca ( % 94) Fourty six patmnts received radiotherapy post-operatively because they had high risk for recurrence such as positive surgical margins or lymph node involvement wdh or without extracapsular invasion Adluvant radiotherapy doses were 50 Gy to the primary sde and to the neck and a boost dose of 10 Gy to the high risk region Thirty three pahents received definihve radiotherapy Of these patients 13 recegved radiotherapy with altered fractionatlon schemes wdh or wdhout concomittant chemotherapy, and the rest of the group radiotherapy was given conventionally In adjuvant radiotherapy group survival rate at 48 months was 45 % whde It was 23 8 % at 30 months in the definitive radtotherapy group m whmh most of the locally advanced patients were included Five year acturlal survival was 14 % in the relapsed group Surgery and radiotherapy must be the preffered treatment modality tn suttable cases
376 SPLIT H Y P E R F R A C T I O N A T E D A C C E L E R A T E D RADIATION THERAPY (SHART) FOR L O C A L L Y ADVANCED L A R Y N G E A L CARCINOMA AS AN ORGANSPARING APPROACH F. Arias, M.T. Duenas, M.A. Dominguez, E. Martinez, J.J. Illarramendi, E. Villafranca, R. Meirino, M. Tejedor, F. Molina, S. Migueliz, J.J. Valerdi Dept. Oncology, Hospital de Navarra, Spain. From May 1990 to November 1995, 45 patients (p) with locally advanced laryngeal carcinoma (39p) or ineligible for conservative surgery (6p) were treated in our department with CDDP (20 mg/sqm/days I to 5) and SHART, 64-67.2 Gy, 160 cGy/fx, days 1-5, 8-12, 15-16, 31-33 and 36-40 (41) (Wang, CC: ISROBP 86, 12: 3-7). Functional neck dissection for N>3 cm and radical laryngectomy if non complete response (CR). Patients characteristics : 45 p (44 M, 1 F). Age 38-77. Median follow-up 39 m. 02-66). AJC stage: II, 4 p (9%), Ill 13 p (29%), IV 28 p (62%). Results : 38/45 CR (84%). Laryngectomy, 3 p 2 and 5 years overall survival : 74% (IC 95%: 61%-87%) and 57% (IC 95% : 39% - 64%). 2 and 5 years DFS 64% and 54%. Of the series, 16 p have died : local progression 4 p, local relapse 6 p, MTS without LR 2 p. Tumoral cachexie, 1 p 2nd tumours, 3 p. Conclusions : with a significant acute toxicity but a low rate of late effects, our results confirm the preliminary expectatives of achievement, with this treatment, a high rate of survival and local control with larynx preservation for this group of patients.
HYPERFRACTIONATED RADIOTHERAPY (RT) IN HEAD AND NECK CARCINOMA WITH SPECIAL REFERENCE TO HIGH DOSE PREOPERATIVE TREATMENT R Valavaara, K Aitasalo, H Minn, J Kulmala, R Grenman, J Suonp~i~i, E Nordman. Department of Radiotherapy and Oncology and Department of Otorhinolaryngology, University Central Hospital, Turku, Finland Various types of hyperfractionation have been studied in the radiotherapy of head and neck carcinomas with improvements in the outcome of patients. On the other hand higher preoperative doses of RT can be delivered if more sophisticated surgical techniques are used. Patients and methods: We have treated 48 patients (14 female, 34 male, mean age 64,5 y) with squamous cell carcinoma in the head and neck region with accelerated hyperfractionated RT (model by CC Wang) with a median follow up time of 398 days. 16 pts had cancer in oral cavity, 16 in larynx, I I in pharynx, 4 nasal cavities and l unknown primary. 50% had stage 4, 19% stage 3 and 31% stage 2 disease. 36 of the patients were operated after 60-69 Gy. The median preoperative dose was 63.5 Gy and radical dose 68 Gy. After a median of 37.4 Gy patients had a break of I1 d (range 9-18 d). Total treatment time was 37 d (range 28-47 d) and the time from RT to operation was 29 d (range 19-42 d). Results: All of the 36 operated patients had a complete remission, 50 % of them had negative histopathologic specimen at the operation. 11 of 12 patients treated with radical RT had a complete remission. During the follow up time 7 patients had a recurrence and 8 patients have died. All patients had grade 3-4 mucositis. Median weight loss was 4 kg (range 0-13 kg). 22 patients needed weak or strong opioids to relieve pain during the treatment. 4 patients had symptomatic fibrosis in the neck and 2 patients had protracted oedema. Acute reactions were strong but tolerable and operative complications were not increased.
377 TREATMENT OF THE FLOOR OF MOUTH AND TONGUE" CANCER IN THE RADIOTHERAPY DEPARTMENT OF POITIERS BETWEEN 1982 AND 1991. O. ~adier I, D. Jadaud:, J.M. Descrozailles~, Z. GacF, A. Daban:. I Dep. of Radiotherapy, G6ttingen, Germany, 2 Dep. of Radiotherapy, Poitiers, France, 3 Dep. of maxillary faecial surgery, Poitiers, France Backgroud: Comparison of our results by oral cavity carcinoma with the literature. Purpose: To appreciate the results of different treatment regimens of floor of mouth and base of tongue carcinoma in order to improve our patient care. Materials and methods: Between 1982 and 1991 61 patients with a carcinoma ofthe floor ofmouth and 30 with a tongue cancer (26 Tl, 24 T2, 22 T3, 19 1"4) were treated in the radiotherapy department of Poitiers. 9 patients with TIN0 tumor were treated with low dose brachytherapy only with a total dose of 70 Cry without nodal dissection. The T2 and T3 turnouts were treated with combined surgery and radiotherapy. A nodal dissection was involved. The T4 were treated either ~argically if possible or with combined chemotherapy and radiation. Results: The 5 year overall survival was 71% for the TI, without sigulficative difference between the surgery/brachytherapy groups, 43% for the T2, 23% for the T3, and 0 for the T4. Most relapses appeared in the first two years. In the TIN0 group there were nodal relapses in 45 %. Complications of radiotherapy were acceptable. 4 cases of osteonecrosis were observed after radiotherapy. All of these appeared simultaneously with a local relapse. Conclusion: These results are comparable with reports in the literature. The remarkable observation of our study is the high incidence of nodal recurrences after local treatment of TIN0 tumors. Therefore local treatment is insufficient for early stage tumors. It should be possible in the future to discriminate agressive tumors by predictive testing, local treatment could be an option for small tumors, without agressive parameter. Howewer, at the current stage nodal irradiation is advocated.
375 R E S U L T S IN O R A L C A V I T Y A N D CARCINOMAS
Ataman O. Sen M. Akman F , Gorken I B. TuzcuotJluG. Gunen E A Gunbay U , Alanyall H , (~ehngozR, Kmay M ,Sutay S, Pabucrcuo~lluU , Ada E, CeP/-anK Dokuz EylUl Medical School Head and Neck Cancer Group IZMIRTURKIYE Oral cavity cancer represents many diseases Treatment of these turnouts depends on the Iocahsahon, extent and performance status of the pahent Surgery or radiation therapy ts the mainstay of treatment in early stages In advanced cases, combined modahty treatment ts preferred Etghty stx patmnts wdh oral cawty and oropharynx carcinomas were treated between July 1991 January 1996 and the results were analysed retrospectively They were 58 males and 28 females, at the mean age of 59 (32-83) One patient was stage 0 ( Tis NO ) , 10 pts were stage I ( T I N 0 ) , 7 pts were stage tl ( T2N0 ) . 20 pts were stage III ( T3N0 6, TIN1 2, T2N1 6. T3N1 6 ) . 33 pts were stage IV ( T2N2 1, T3N2 1, T4N0 7. T4N1 9 T4N2 14. T4N3 1 } Nine patients were treated after salvage surgery and thetr stages could not be assesed Seven pahents had local and / or regional relaps at their referrat Most of the pahents were eptdermo=d ca ( % 94) Fourty six patmnts received radiotherapy post-operatively because they had high risk for recurrence such as positive surgical margins or lymph node involvement wdh or without extracapsular invasion Adluvant radiotherapy doses were 50 Gy to the primary sde and to the neck and a boost dose of 10 Gy to the high risk region Thirty three pahents received definihve radiotherapy Of these patients 13 recegved radiotherapy with altered fractionatlon schemes wdh or wdhout concomittant chemotherapy, and the rest of the group radiotherapy was given conventionally In adjuvant radiotherapy group survival rate at 48 months was 45 % whde It was 23 8 % at 30 months in the definitive radtotherapy group m whmh most of the locally advanced patients were included Five year acturlal survival was 14 % in the relapsed group Surgery and radiotherapy must be the preffered treatment modality tn suttable cases
376 SPLIT H Y P E R F R A C T I O N A T E D A C C E L E R A T E D RADIATION THERAPY (SHART) FOR L O C A L L Y ADVANCED L A R Y N G E A L CARCINOMA AS AN ORGANSPARING APPROACH F. Arias, M.T. Duenas, M.A. Dominguez, E. Martinez, J.J. Illarramendi, E. Villafranca, R. Meirino, M. Tejedor, F. Molina, S. Migueliz, J.J. Valerdi Dept. Oncology, Hospital de Navarra, Spain. From May 1990 to November 1995, 45 patients (p) with locally advanced laryngeal carcinoma (39p) or ineligible for conservative surgery (6p) were treated in our department with CDDP (20 mg/sqm/days I to 5) and SHART, 64-67.2 Gy, 160 cGy/fx, days 1-5, 8-12, 15-16, 31-33 and 36-40 (41) (Wang, CC: ISROBP 86, 12: 3-7). Functional neck dissection for N>3 cm and radical laryngectomy if non complete response (CR). Patients characteristics : 45 p (44 M, 1 F). Age 38-77. Median follow-up 39 m. 02-66). AJC stage: II, 4 p (9%), Ill 13 p (29%), IV 28 p (62%). Results : 38/45 CR (84%). Laryngectomy, 3 p 2 and 5 years overall survival : 74% (IC 95%: 61%-87%) and 57% (IC 95% : 39% - 64%). 2 and 5 years DFS 64% and 54%. Of the series, 16 p have died : local progression 4 p, local relapse 6 p, MTS without LR 2 p. Tumoral cachexie, 1 p 2nd tumours, 3 p. Conclusions : with a significant acute toxicity but a low rate of late effects, our results confirm the preliminary expectatives of achievement, with this treatment, a high rate of survival and local control with larynx preservation for this group of patients.
HYPERFRACTIONATED RADIOTHERAPY (RT) IN HEAD AND NECK CARCINOMA WITH SPECIAL REFERENCE TO HIGH DOSE PREOPERATIVE TREATMENT R Valavaara, K Aitasalo, H Minn, J Kulmala, R Grenman, J Suonp~i~i, E Nordman. Department of Radiotherapy and Oncology and Department of Otorhinolaryngology, University Central Hospital, Turku, Finland Various types of hyperfractionation have been studied in the radiotherapy of head and neck carcinomas with improvements in the outcome of patients. On the other hand higher preoperative doses of RT can be delivered if more sophisticated surgical techniques are used. Patients and methods: We have treated 48 patients (14 female, 34 male, mean age 64,5 y) with squamous cell carcinoma in the head and neck region with accelerated hyperfractionated RT (model by CC Wang) with a median follow up time of 398 days. 16 pts had cancer in oral cavity, 16 in larynx, I I in pharynx, 4 nasal cavities and l unknown primary. 50% had stage 4, 19% stage 3 and 31% stage 2 disease. 36 of the patients were operated after 60-69 Gy. The median preoperative dose was 63.5 Gy and radical dose 68 Gy. After a median of 37.4 Gy patients had a break of I1 d (range 9-18 d). Total treatment time was 37 d (range 28-47 d) and the time from RT to operation was 29 d (range 19-42 d). Results: All of the 36 operated patients had a complete remission, 50 % of them had negative histopathologic specimen at the operation. 11 of 12 patients treated with radical RT had a complete remission. During the follow up time 7 patients had a recurrence and 8 patients have died. All patients had grade 3-4 mucositis. Median weight loss was 4 kg (range 0-13 kg). 22 patients needed weak or strong opioids to relieve pain during the treatment. 4 patients had symptomatic fibrosis in the neck and 2 patients had protracted oedema. Acute reactions were strong but tolerable and operative complications were not increased.
377 TREATMENT OF THE FLOOR OF MOUTH AND TONGUE" CANCER IN THE RADIOTHERAPY DEPARTMENT OF POITIERS BETWEEN 1982 AND 1991. O. ~adier I, D. Jadaud:, J.M. Descrozailles~, Z. GacF, A. Daban:. I Dep. of Radiotherapy, G6ttingen, Germany, 2 Dep. of Radiotherapy, Poitiers, France, 3 Dep. of maxillary faecial surgery, Poitiers, France Backgroud: Comparison of our results by oral cavity carcinoma with the literature. Purpose: To appreciate the results of different treatment regimens of floor of mouth and base of tongue carcinoma in order to improve our patient care. Materials and methods: Between 1982 and 1991 61 patients with a carcinoma ofthe floor ofmouth and 30 with a tongue cancer (26 Tl, 24 T2, 22 T3, 19 1"4) were treated in the radiotherapy department of Poitiers. 9 patients with TIN0 tumor were treated with low dose brachytherapy only with a total dose of 70 Cry without nodal dissection. The T2 and T3 turnouts were treated with combined surgery and radiotherapy. A nodal dissection was involved. The T4 were treated either ~argically if possible or with combined chemotherapy and radiation. Results: The 5 year overall survival was 71% for the TI, without sigulficative difference between the surgery/brachytherapy groups, 43% for the T2, 23% for the T3, and 0 for the T4. Most relapses appeared in the first two years. In the TIN0 group there were nodal relapses in 45 %. Complications of radiotherapy were acceptable. 4 cases of osteonecrosis were observed after radiotherapy. All of these appeared simultaneously with a local relapse. Conclusion: These results are comparable with reports in the literature. The remarkable observation of our study is the high incidence of nodal recurrences after local treatment of TIN0 tumors. Therefore local treatment is insufficient for early stage tumors. It should be possible in the future to discriminate agressive tumors by predictive testing, local treatment could be an option for small tumors, without agressive parameter. Howewer, at the current stage nodal irradiation is advocated.