- Email: [email protected]
830 Poster Effect of postoperative radiotherapy on local control and survival in adenoid cystic carcinoma of the head and neck
$246 Friday/Saturday, 20-21 September 2002
but that three fields were significantly worse. This study was restricted to investigate five field IMRT plans. Dose verification was carried out for the IMRT plans using a pinpoint ionisation chamber and an in-house phantom with inhomogeneous inserts to represent the spinal cord and gullet. Fluence verification was carried out using film. Results: All data are given for conventional and IMRT techniques respectively, Dose range (defined as dose value between the 99% and 1% volume on the dose volume histogram): Uniform 50 Gy irradiation: Larynx PTV 12.3 Gy and 2.9 Gy (p=0.03), Nodes 18.2 Gy and 6.3 Gy (p=0.001) Boosted 65 Gy plans: Larynx PTV 15.5 Gy and 4.6 Gy (p=0.03), Nodes 29.4 Gy and I1.0 Gy (p=0.001) Spinal cord maxima: Uniform 50 Gy irradiation: 42.4 Gy and 37.2 Gy (p=0.01) Boosted 65 Gy plans: 42.5 Gy and 37.9 Gy (p=0.01) The dose verification gave a mean error of 0.2% (_+1.0%) Conclusions: IMRT offers improved target homogeneity in patients with larynx carcinoma and also reduces dose to the spinal cord. This sparing of normal tissue structures is sufficient that dose-escalation of both the larynx and lymph nodes is possible. A quality assurance technique for IMRT in the head and neck has been developed. A clinical trial is now underway, 828 Poster B i o l o g i c a l characterization and early response monitoring in
head and neck cancer using multislice perfusion CT G. Grabenbauer1, B. Adamietz 1, A. Muresan2, W. Roemec3 1University of Erlangen, Radiation Therapy and Oncology, Erlangen, Germany 2University of Erlangen, Medical Physics, Erlangen, Germany 3University of Erlangen, Diagnostic Radiology, Erlangen, Germany Purpose: Squamous cell carcinoma of the head and neck show considerable variation in perfusion pattern and biological behavior as well as response to chemoradiation. Fast serial acquisition of multislice CT (MSCT) data after intravenous contrast medium bolus injection allows quantification of tumor perfusion. The aim of this study was to assess treatment induced changes of tumor perfusion early after initiation of tumor treatment using dedicated software to calculate parametric images and to correlate these findings with tumor response at 30 Gy. Patients & Methods: Dynamic MSCT was performed in 29 patients (pts) with histologically proven advanced head and neck cancer (stage tV UICC) before and 3 weeks after initiation of chemoradiation (CRT). All pts had accelerated external radiation with concurrent chemotherapy using 5-FU and cisplatin as part of an ongoing trial. After bolus injection of 80 ml contrast medium (Imeron 400, flow 8 ml/sec), double 10 mm-slices through the largest tumor region were scanned for 40 sec (Siemens SOMATOM Volume Zoom). The arterial input function was derived from the largest arterial vessel in the field of view. A tissue time-density curve was derived from a tumor region of interest (ROI). Perfusion values were calculated using graphical analysis and displayed as parametric color coded images. These values represent the average perfusion in the ROI. The tumor area was determined as the product of maximum perpendicular diameters. Results: At baseline, all tumor lesions as well as metastatic lymph nodes were visible in parametric images by enhanced perfusion values (0.441 ml/min/ml + 0.166), however, the perfusion pattern was very inhomogeneous. The mean tumor area was 802 mm2 + 473. Three weeks after initiation of CRT (30 Gy and 1 course of 5-FU, cisplatin), tumor perfusion decreased to 0.399 ml/min/ml + 0.170, tumor area decreased to 435 mm =+ 318. There was no correlation between perfusion and tumor size changes (r = 0.185). Responding tumors (>50% reduction of tumor area) exhibited higher perfusion values (p = 0.01 ) before CRT and perfusion decrease was more prominent in responding tumors, Conclusion: These results indicate that CRT induces significant changes of tumor perfusion. Standardized assessment is possible by perfusion CT. Multislice perfusion CT is a potential tool for biological characterization and response monitoring in head and neck tumors, 829
Poster
Feasibility of accelerated radiotherapy with concomitant boost technique in elderly patients J.A. Laneendiik. P. Doomaert, n.J. S/otman Vrije Universiteit Medica/ Center, Radiation Onco/ogy, Amsterdam, The Netherlands
Posters
Purpose: The aim of this prospective study was to evaluate the feasibility of accelerated radiotherapy with concomitant boost technique (AR-CCB) in elderly patients (> 70 years) with squamous cell carcinoma of the head and neck. Material and methods: Thirty-four elderly patients aged > 70 years (mean 79, range 71-97) with carcinoma of the oral cavity, oropharynx, hypopharynx or larynx were treated with a planned dose of 70 Gy in 6 weeks (2 Gy/fraction, 6 times a week). All patients had a WHO performance status 02. Acute toxicity was scored on a weekly basis up to 6 weeks after radiation using the RTOG acute morbidity scoring system. Analysis was performed using repeated measures ANOVA. In addition, consequential late toxicity during the first 6 months was scored using the RTOG scoring system for late toxicity. The group of elderly patients was compared with 49 patients aged _<70 years (mean 59, 40-70 years) who were treated with the same regimen. Results: The planned treatment was completed within 6 weeks in all cases. There were no treatment interruptions. There was no difference in survival between the elderly and younger patients. No differences were observed between the elderly and younger patients with regard to acute toxicity, including dermatitis, mucositis, acute xerostomia, pharyngitis/oesophagitis and laryngeal toxicity. Changes in performance status and weight were simliar in both groups. Grade Ill mucositis was observed in 79% of the younger and in 66% of the elderly patients (ns). Nasogastric tube feeding during treatment was necessary in 21% of the younger and 31% of the elderly patients (p=0.44). Consequential grade Ill-IV late mucosal toxicity was observed in 5 younger patients (10%) and in 1 elderly patient (3%). Nasogastric tube feeding/percutanuous gastronomy in the first 6 months after radiation was needed in 14% of the younger and 11% of the elderly patients. No other complications in the first 6 months were observed. Conclusion: In the current study, AR-CCB could be administered safely in the population of elderly patients with head and neck cancer. Acute and consequential late toxicity remained within acceptable limits and was not different from that observed in younger patients. Based on these results, elderly patients should not be denied access to accelerated radiotherapy relative to age alone. 830
Poster
Effect of postoperative radiotherapy on local control and s u r vival in adenoid cystic carcinoma of the head and neck J. Johansen 1, P.P. Clausen2, O. Hanson3, K. Jergensen4, M. Jensen 3, L. Bastholt3 1The Finsen Center, Rigshospitalet, Department of Oncology, Copenhagen,Denmark 2NaestvedSygehus, Department of Pathology, Nmstved, Denmark 30dense University Hospital, Department of Oncology, Odense, Denmark 40dense University Hospital, Department of ENT and Head and Neck Surgery,Odense, Denmark Purpose: The effect of combined surgery and radiotherapy on local-regional control and survival was investigated in patients with adenoid cystic carcinema (ACC) of the head and neck. Methods: A retrospective study of 67 patients with ACC treated between 1970-1995. Extended follow-up data were obtained from national patient registries regarding survival and causes of death to produce life-table analysis comprising more than 25 years of follow-up. A histopathological review was done to classify tumors as either tubular, cribriform, or solid carcinomas. Cox's proportional hazard regression model was applied to discern independent prognostic variables of survival. Results: The 5- and 10-year actuarial local-regional control rates were 78% and 66%, respectively. 10-year cause-specific and overall survival were 66% and 47%, respectively. Increasing T-size as well as a solid tumor histology were independently associated with both local-regional failure and survival rates on multivariate analysis. After radical surgery, postoperative radiotherapy significantly improved the 10-year local-regional tumor control to 100% compared with 58% after surgery alone (p=0.012). The equivalent 10-year figure was 52% after an incomplete tumor resection followed by postoperative radiotherapy. The cumulative incidence of distant metastatic disease for the whole study period was 27% (18/67). The 10-year causespecific survival estimate of 79% in patients with a radical resection and additional radiotherapy was insignificantly better than the 67% for those with a complete resection without radiotherapy. Conclusion: ACC of the head and neck is a radiosensitive malignancy. Excellent local control rates were obtained by combined surgery and postoperative radiotherapy, however, survival rates were not affected by additional radiation treatment due to a high proportion of patients with distant metastatic disease.
but that three fields were significantly worse. This study was restricted to investigate five field IMRT plans. Dose verification was carried out for the IMRT plans using a pinpoint ionisation chamber and an in-house phantom with inhomogeneous inserts to represent the spinal cord and gullet. Fluence verification was carried out using film. Results: All data are given for conventional and IMRT techniques respectively, Dose range (defined as dose value between the 99% and 1% volume on the dose volume histogram): Uniform 50 Gy irradiation: Larynx PTV 12.3 Gy and 2.9 Gy (p=0.03), Nodes 18.2 Gy and 6.3 Gy (p=0.001) Boosted 65 Gy plans: Larynx PTV 15.5 Gy and 4.6 Gy (p=0.03), Nodes 29.4 Gy and I1.0 Gy (p=0.001) Spinal cord maxima: Uniform 50 Gy irradiation: 42.4 Gy and 37.2 Gy (p=0.01) Boosted 65 Gy plans: 42.5 Gy and 37.9 Gy (p=0.01) The dose verification gave a mean error of 0.2% (_+1.0%) Conclusions: IMRT offers improved target homogeneity in patients with larynx carcinoma and also reduces dose to the spinal cord. This sparing of normal tissue structures is sufficient that dose-escalation of both the larynx and lymph nodes is possible. A quality assurance technique for IMRT in the head and neck has been developed. A clinical trial is now underway, 828 Poster B i o l o g i c a l characterization and early response monitoring in
head and neck cancer using multislice perfusion CT G. Grabenbauer1, B. Adamietz 1, A. Muresan2, W. Roemec3 1University of Erlangen, Radiation Therapy and Oncology, Erlangen, Germany 2University of Erlangen, Medical Physics, Erlangen, Germany 3University of Erlangen, Diagnostic Radiology, Erlangen, Germany Purpose: Squamous cell carcinoma of the head and neck show considerable variation in perfusion pattern and biological behavior as well as response to chemoradiation. Fast serial acquisition of multislice CT (MSCT) data after intravenous contrast medium bolus injection allows quantification of tumor perfusion. The aim of this study was to assess treatment induced changes of tumor perfusion early after initiation of tumor treatment using dedicated software to calculate parametric images and to correlate these findings with tumor response at 30 Gy. Patients & Methods: Dynamic MSCT was performed in 29 patients (pts) with histologically proven advanced head and neck cancer (stage tV UICC) before and 3 weeks after initiation of chemoradiation (CRT). All pts had accelerated external radiation with concurrent chemotherapy using 5-FU and cisplatin as part of an ongoing trial. After bolus injection of 80 ml contrast medium (Imeron 400, flow 8 ml/sec), double 10 mm-slices through the largest tumor region were scanned for 40 sec (Siemens SOMATOM Volume Zoom). The arterial input function was derived from the largest arterial vessel in the field of view. A tissue time-density curve was derived from a tumor region of interest (ROI). Perfusion values were calculated using graphical analysis and displayed as parametric color coded images. These values represent the average perfusion in the ROI. The tumor area was determined as the product of maximum perpendicular diameters. Results: At baseline, all tumor lesions as well as metastatic lymph nodes were visible in parametric images by enhanced perfusion values (0.441 ml/min/ml + 0.166), however, the perfusion pattern was very inhomogeneous. The mean tumor area was 802 mm2 + 473. Three weeks after initiation of CRT (30 Gy and 1 course of 5-FU, cisplatin), tumor perfusion decreased to 0.399 ml/min/ml + 0.170, tumor area decreased to 435 mm =+ 318. There was no correlation between perfusion and tumor size changes (r = 0.185). Responding tumors (>50% reduction of tumor area) exhibited higher perfusion values (p = 0.01 ) before CRT and perfusion decrease was more prominent in responding tumors, Conclusion: These results indicate that CRT induces significant changes of tumor perfusion. Standardized assessment is possible by perfusion CT. Multislice perfusion CT is a potential tool for biological characterization and response monitoring in head and neck tumors, 829
Poster
Feasibility of accelerated radiotherapy with concomitant boost technique in elderly patients J.A. Laneendiik. P. Doomaert, n.J. S/otman Vrije Universiteit Medica/ Center, Radiation Onco/ogy, Amsterdam, The Netherlands
Posters
Purpose: The aim of this prospective study was to evaluate the feasibility of accelerated radiotherapy with concomitant boost technique (AR-CCB) in elderly patients (> 70 years) with squamous cell carcinoma of the head and neck. Material and methods: Thirty-four elderly patients aged > 70 years (mean 79, range 71-97) with carcinoma of the oral cavity, oropharynx, hypopharynx or larynx were treated with a planned dose of 70 Gy in 6 weeks (2 Gy/fraction, 6 times a week). All patients had a WHO performance status 02. Acute toxicity was scored on a weekly basis up to 6 weeks after radiation using the RTOG acute morbidity scoring system. Analysis was performed using repeated measures ANOVA. In addition, consequential late toxicity during the first 6 months was scored using the RTOG scoring system for late toxicity. The group of elderly patients was compared with 49 patients aged _<70 years (mean 59, 40-70 years) who were treated with the same regimen. Results: The planned treatment was completed within 6 weeks in all cases. There were no treatment interruptions. There was no difference in survival between the elderly and younger patients. No differences were observed between the elderly and younger patients with regard to acute toxicity, including dermatitis, mucositis, acute xerostomia, pharyngitis/oesophagitis and laryngeal toxicity. Changes in performance status and weight were simliar in both groups. Grade Ill mucositis was observed in 79% of the younger and in 66% of the elderly patients (ns). Nasogastric tube feeding during treatment was necessary in 21% of the younger and 31% of the elderly patients (p=0.44). Consequential grade Ill-IV late mucosal toxicity was observed in 5 younger patients (10%) and in 1 elderly patient (3%). Nasogastric tube feeding/percutanuous gastronomy in the first 6 months after radiation was needed in 14% of the younger and 11% of the elderly patients. No other complications in the first 6 months were observed. Conclusion: In the current study, AR-CCB could be administered safely in the population of elderly patients with head and neck cancer. Acute and consequential late toxicity remained within acceptable limits and was not different from that observed in younger patients. Based on these results, elderly patients should not be denied access to accelerated radiotherapy relative to age alone. 830
Poster
Effect of postoperative radiotherapy on local control and s u r vival in adenoid cystic carcinoma of the head and neck J. Johansen 1, P.P. Clausen2, O. Hanson3, K. Jergensen4, M. Jensen 3, L. Bastholt3 1The Finsen Center, Rigshospitalet, Department of Oncology, Copenhagen,Denmark 2NaestvedSygehus, Department of Pathology, Nmstved, Denmark 30dense University Hospital, Department of Oncology, Odense, Denmark 40dense University Hospital, Department of ENT and Head and Neck Surgery,Odense, Denmark Purpose: The effect of combined surgery and radiotherapy on local-regional control and survival was investigated in patients with adenoid cystic carcinema (ACC) of the head and neck. Methods: A retrospective study of 67 patients with ACC treated between 1970-1995. Extended follow-up data were obtained from national patient registries regarding survival and causes of death to produce life-table analysis comprising more than 25 years of follow-up. A histopathological review was done to classify tumors as either tubular, cribriform, or solid carcinomas. Cox's proportional hazard regression model was applied to discern independent prognostic variables of survival. Results: The 5- and 10-year actuarial local-regional control rates were 78% and 66%, respectively. 10-year cause-specific and overall survival were 66% and 47%, respectively. Increasing T-size as well as a solid tumor histology were independently associated with both local-regional failure and survival rates on multivariate analysis. After radical surgery, postoperative radiotherapy significantly improved the 10-year local-regional tumor control to 100% compared with 58% after surgery alone (p=0.012). The equivalent 10-year figure was 52% after an incomplete tumor resection followed by postoperative radiotherapy. The cumulative incidence of distant metastatic disease for the whole study period was 27% (18/67). The 10-year causespecific survival estimate of 79% in patients with a radical resection and additional radiotherapy was insignificantly better than the 67% for those with a complete resection without radiotherapy. Conclusion: ACC of the head and neck is a radiosensitive malignancy. Excellent local control rates were obtained by combined surgery and postoperative radiotherapy, however, survival rates were not affected by additional radiation treatment due to a high proportion of patients with distant metastatic disease.