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710 poster Comparison of clinical target volume in PET-CT and CT-scan based treatment planning in patients with head and neck cancer
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Posters
709 poster
710 poster
Concomitant chemoradiotherapy with weekly Cisplatin and subcutaneous Amifostin in the treatment of advanced head and neck cancer
Comparison of clinical target volume in PET-CT and CTscan based treatment planning in patients with head and neck cancer
M. Pala 1, P. Holeckova ~, P. Vitek ~, J. Kubes ~, J. VeselS, A. Svobodnik 3 ~lnstitute of Radiation Oncology University Hospital Bulovka, Department of Radiation Oncology, Prague, Czech Republic 2University Hospital Bulovka, Department of Otorhinolaryngology, Prague, Czech Republic 3Center for Information Science and Analysis Masaryk Memorial Cancer Institute, Brno, Czech Republic
A. van Baardwijk 1, F. Koppe ~, P. van den Ende 1, J. de Jong ~, B. Kremer2, M. van Kroonenburgh 3, B. de Bondt4, M. Oellers ~, P. Lamb#) ~, D. de Ruysscher1 I MAASTRO cfinic, Radiation Oncology, Maastricht, The Netherlands 2Academic Hospital Maastricht, Otorhinolaryngology and Head and Neck Surgery, Maastricht, The Netherlands 3Academic Hospital Maastricht, Nuclear Medicine, Maastricht, The Netherlands 4Academic Hospital Maastricht, Radiology, Maastricht, The Netherlands
Purpose: To demonstrate the efficacy and feasibility of chemoradiotherapy with weekly cisplatin and subcutaneous amifostin in the treatment of Ioco(regional) advanced head and neck cancer. Patients and Methods: Between February 2002 and April 2004, 54 consecutive patients (pts.) [WHO < 2, male to female ratio 46/8, median age 56 years (35-68)] with head and neck cancer were treated. Tumours of the oropharynx (53%) and hypopharynx (13%) were most frequent and stage IV (TNM 1997) was predominant (89%). Radiotherapy consisted of 70Gy/7weeks/35 fraction without (41 pts.) or after R1/2 resection (6 pts.) or 60Gy/6 weeks/30 fraction after R0 resection (5 pts.) or in a case of reirradiation (2 pts.). In most of cases we used the three field radiation technique with two lateral opposite wedged fields and a direct posterior field with central shielding block protecting spinal cord. All patients received concurrent chemotherapy with cisplatin 40mg/m 2 weekly and amifostin 500mg subcutaneously 20-30 min. prior to each radiotherapy fraction. The radiotherapy was combined with hyperthermia in 26% (14pts.). Prophylactic percutane0us endoscopic gastrostomy was itroduced in 87% (47 pts.). The endpoints of the study included initial tumor response (according to WHO), toxicity to radiochemotherapy and subcutaneous amifostin (according to RTOG and NCI-CTT) and survival. Results: The median duration of follow up was 15 months (228). Median total tumor dose was 70Gy (26-74), median number of chemotherapy courses 5 (1-8), median radiotherapy duration 51 days (18-68). Of the 48 pts. evaluable for response 77% (37 pts.) achieved complete response and 10% (5 pts.) partial response. Median overall survival is 12,9 months. Acute mucositis grade 3 were reported in 43% (23 pts.), acute dermatitis grade 3/4 in 17% (9 pts.), acute xerostomy grade 2 in 69% (37 pts.), acute dysphagia grade 3 in 43% (23 pts.). One case of larynx toxicity grade 4 was recorded. Median loss of weight was 7kg (10% of pretreatment value) (20-2). Grade 3/4 neutropenia occurred in 35% (19 pts.) and it was the most frequent reason for termination of concomitant chemotherapy. Renal toxicity was in general mild. 13% (7 pts.) discontinued radiotherapy due to treatment-related toxicity. Skin :rush grade 2/3 developed in 19% (10 pts.), 19% (10 pts.) interrupted administration of amifostine due to toxicities. The late toxicities were mild, predominantly subcutaneous fibrosis grade 1/2 and xerostomia grade 1/2 in most of cases. Conclusion: Concomitant chemoradiotherapy with weekly cisplatin and subcutaneous amifostin is toxic, but tolerable and highly active in term of initial response. Despite that, the overall survival of patients with Ioco(regional) advanced head and neck cancer evaluated in this study remains poor. For definitive conclusion long term follow-up is necessary.
Introduction: Combined PET-CT with FDG has recently shown to have a high diagnostic accuracy for head and neck cancer. We therefore investigated prospectively the potential gain of PET-CT delineation using a dedicated combined PET-CT-simulator in head and neck cancer patients referred for radical radiotherapy. Materials and Methods: From February 2004 onwards, all patients referred for radical radiotherapy for head and neck ,cancer have undergone a pre-treatment simulation on a dedicated combined PET-CT-simulator (Biograph TM , Siemens). For each patient two delineations of clinical target volume (CTV) were made: one on base of CT information alone and one on base of PET-CT information. Results: Out of 18 patients, 5 had significant FDG uptake in their primary tumour. In 13 patients no FDG uptake was seen: 3 patients with carcinoma in situ, 4 with a cT1 lesion, and 6 with microscopically positive margins postoperatively. Of the remaining 5 the CT based CTV was 376 ml + 66.7 ml vs. 369 ml + 74.7 ml for the PET-CT based CTV (p=0.76). The CTV on PET-CT extended beyond the CTV CT in 4 out of 5 patients for a mean volume of 48 ml + 22.6 ml. There was an overlap between CTV CT and CTV PET-CT in 84.4 % + 5.6 % of the volume. Conclusions: The first data suggest that target volumes will change according to PET-CT information compared with CT in case of macroscopic disease. As accrual of patients continues, more mature data will be presented at the meeting.
711 poster Prognostic factors of combined modality treatment in patients with laryngeal cancer basing on scale of risk of recurrence
A. Mucha-Malecka, K. Skladowski Center of Oncology, Radiotherapy Department, Cracow, Poland Purpose: The evaluation of prognostic value of clinical and histopathological factors and assessment of clinical usefulness of modified Peters' scale of risk of recurrence. Material and methods: Between 1994-96 197 pts were irradiated after surgery. Partial resections of the larynx were performed in 42(21%) of patients (pts), total resections in 155 pts (79%). Preoperative analysis revealed advanced laryngeal cancer (T3-4) in 67% of pts and absence of neck nodes metastases (NO) in 63% of pts and respectively 72% and 65% in postoperative analysis. Macroscopic nonradicalism was noted in 4 pts (10%) after partial resections and in 11 pts (7%) after total resections. Microscopic nonradicalism was noted in 13 pts (31%) after partial resections and in 31 pts (20%) after total resections. In 16 pts (28%)
Posters
709 poster
710 poster
Concomitant chemoradiotherapy with weekly Cisplatin and subcutaneous Amifostin in the treatment of advanced head and neck cancer
Comparison of clinical target volume in PET-CT and CTscan based treatment planning in patients with head and neck cancer
M. Pala 1, P. Holeckova ~, P. Vitek ~, J. Kubes ~, J. VeselS, A. Svobodnik 3 ~lnstitute of Radiation Oncology University Hospital Bulovka, Department of Radiation Oncology, Prague, Czech Republic 2University Hospital Bulovka, Department of Otorhinolaryngology, Prague, Czech Republic 3Center for Information Science and Analysis Masaryk Memorial Cancer Institute, Brno, Czech Republic
A. van Baardwijk 1, F. Koppe ~, P. van den Ende 1, J. de Jong ~, B. Kremer2, M. van Kroonenburgh 3, B. de Bondt4, M. Oellers ~, P. Lamb#) ~, D. de Ruysscher1 I MAASTRO cfinic, Radiation Oncology, Maastricht, The Netherlands 2Academic Hospital Maastricht, Otorhinolaryngology and Head and Neck Surgery, Maastricht, The Netherlands 3Academic Hospital Maastricht, Nuclear Medicine, Maastricht, The Netherlands 4Academic Hospital Maastricht, Radiology, Maastricht, The Netherlands
Purpose: To demonstrate the efficacy and feasibility of chemoradiotherapy with weekly cisplatin and subcutaneous amifostin in the treatment of Ioco(regional) advanced head and neck cancer. Patients and Methods: Between February 2002 and April 2004, 54 consecutive patients (pts.) [WHO < 2, male to female ratio 46/8, median age 56 years (35-68)] with head and neck cancer were treated. Tumours of the oropharynx (53%) and hypopharynx (13%) were most frequent and stage IV (TNM 1997) was predominant (89%). Radiotherapy consisted of 70Gy/7weeks/35 fraction without (41 pts.) or after R1/2 resection (6 pts.) or 60Gy/6 weeks/30 fraction after R0 resection (5 pts.) or in a case of reirradiation (2 pts.). In most of cases we used the three field radiation technique with two lateral opposite wedged fields and a direct posterior field with central shielding block protecting spinal cord. All patients received concurrent chemotherapy with cisplatin 40mg/m 2 weekly and amifostin 500mg subcutaneously 20-30 min. prior to each radiotherapy fraction. The radiotherapy was combined with hyperthermia in 26% (14pts.). Prophylactic percutane0us endoscopic gastrostomy was itroduced in 87% (47 pts.). The endpoints of the study included initial tumor response (according to WHO), toxicity to radiochemotherapy and subcutaneous amifostin (according to RTOG and NCI-CTT) and survival. Results: The median duration of follow up was 15 months (228). Median total tumor dose was 70Gy (26-74), median number of chemotherapy courses 5 (1-8), median radiotherapy duration 51 days (18-68). Of the 48 pts. evaluable for response 77% (37 pts.) achieved complete response and 10% (5 pts.) partial response. Median overall survival is 12,9 months. Acute mucositis grade 3 were reported in 43% (23 pts.), acute dermatitis grade 3/4 in 17% (9 pts.), acute xerostomy grade 2 in 69% (37 pts.), acute dysphagia grade 3 in 43% (23 pts.). One case of larynx toxicity grade 4 was recorded. Median loss of weight was 7kg (10% of pretreatment value) (20-2). Grade 3/4 neutropenia occurred in 35% (19 pts.) and it was the most frequent reason for termination of concomitant chemotherapy. Renal toxicity was in general mild. 13% (7 pts.) discontinued radiotherapy due to treatment-related toxicity. Skin :rush grade 2/3 developed in 19% (10 pts.), 19% (10 pts.) interrupted administration of amifostine due to toxicities. The late toxicities were mild, predominantly subcutaneous fibrosis grade 1/2 and xerostomia grade 1/2 in most of cases. Conclusion: Concomitant chemoradiotherapy with weekly cisplatin and subcutaneous amifostin is toxic, but tolerable and highly active in term of initial response. Despite that, the overall survival of patients with Ioco(regional) advanced head and neck cancer evaluated in this study remains poor. For definitive conclusion long term follow-up is necessary.
Introduction: Combined PET-CT with FDG has recently shown to have a high diagnostic accuracy for head and neck cancer. We therefore investigated prospectively the potential gain of PET-CT delineation using a dedicated combined PET-CT-simulator in head and neck cancer patients referred for radical radiotherapy. Materials and Methods: From February 2004 onwards, all patients referred for radical radiotherapy for head and neck ,cancer have undergone a pre-treatment simulation on a dedicated combined PET-CT-simulator (Biograph TM , Siemens). For each patient two delineations of clinical target volume (CTV) were made: one on base of CT information alone and one on base of PET-CT information. Results: Out of 18 patients, 5 had significant FDG uptake in their primary tumour. In 13 patients no FDG uptake was seen: 3 patients with carcinoma in situ, 4 with a cT1 lesion, and 6 with microscopically positive margins postoperatively. Of the remaining 5 the CT based CTV was 376 ml + 66.7 ml vs. 369 ml + 74.7 ml for the PET-CT based CTV (p=0.76). The CTV on PET-CT extended beyond the CTV CT in 4 out of 5 patients for a mean volume of 48 ml + 22.6 ml. There was an overlap between CTV CT and CTV PET-CT in 84.4 % + 5.6 % of the volume. Conclusions: The first data suggest that target volumes will change according to PET-CT information compared with CT in case of macroscopic disease. As accrual of patients continues, more mature data will be presented at the meeting.
711 poster Prognostic factors of combined modality treatment in patients with laryngeal cancer basing on scale of risk of recurrence
A. Mucha-Malecka, K. Skladowski Center of Oncology, Radiotherapy Department, Cracow, Poland Purpose: The evaluation of prognostic value of clinical and histopathological factors and assessment of clinical usefulness of modified Peters' scale of risk of recurrence. Material and methods: Between 1994-96 197 pts were irradiated after surgery. Partial resections of the larynx were performed in 42(21%) of patients (pts), total resections in 155 pts (79%). Preoperative analysis revealed advanced laryngeal cancer (T3-4) in 67% of pts and absence of neck nodes metastases (NO) in 63% of pts and respectively 72% and 65% in postoperative analysis. Macroscopic nonradicalism was noted in 4 pts (10%) after partial resections and in 11 pts (7%) after total resections. Microscopic nonradicalism was noted in 13 pts (31%) after partial resections and in 31 pts (20%) after total resections. In 16 pts (28%)