- Email: [email protected]
866 poster ROLE OF FDG PETCT IN DIAGNOSIS AND MANAGEMENT OF OLFACTORY NEUROBLASTOMA.
H EAD N ECK CANCER
866 poster ROLE OF FDG PETCT IN DIAGNOSIS AND MANAGEMENT OF OLFACTORY NEUROBLASTOMA. P. McCloskey1 , M. Moran2 , S. Napier3 , D. Stewart4 , W. Primrose2 , S. Hughes5 1 C LINICAL O NCOLOGY, N ORTHERN I RELAND C ANCER C ENTRE , B ELFAST H EALTH AND S OCIAL C ARE T RUST,, Department of Radiation Oncology, Belfast, United Kingdom 2 N ORTHERN I RELAND R EGIONAL H EAD & N ECK S URGERY U NIT, Head Neck Surgery, Belfast, United Kingdom 3 R OYAL V ICTORIA H OSPITAL, Department of Pathology, Belfast, United Kingdom 4 N ORTHERN I RELAND C ANCER C ENTRE, Clinical Oncology, Belfast, United Kingdom 5 R OYAL V ICTORIA H OSPITAL, Department of Radiology and Nuclear Medicine, Belfast, United Kingdom
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mask yielded high positioning reproducibility for our patients. To spare the parotid gland in the proximity of the target, a fraction of the target volume may not receive the prescribed dose. In the best-achievable plan of our studied cohort, only 43% of parotid gland volumes were treated to more than 30 Gy, while an average of 7,8% of the target volume received less than 95% of the prescribed dose. This is mainly related to the steep dose gradient in the region where the target abuts the parotid gland. The inverse planning system allowed us the freedom of weighting normal tissue-sparing and target coverage to select the best-achievable plan. Local control was achieved in all, but one patients, who showed a PD after six months. Conclusions: A system for patient immobilization, setup verification, and dose optimization for head and neck cancer with parotid sparing without significantly compromising target coverage is being implemented for a tomotherapy-based IMRT plan at the Radiotherapy Division of Lecce Hospital. The initial clinical experience in tumor control is promising, and no severe adverse acute side effects have been observed. 868 poster
Purpose: Olfactory neuroblastoma (ONB) is a rare tumor of neuroectodermal origin that arises from the olfactory epithelium in the roof of the nasal cavity. The stage is highly predictive of survival and local disease has an excellent prognosis. Surgical treatment for localized disease is successful, however there is also a role for postoperative radiotherapy. Radical radiotherapy can be used if surgery is not deemed to be appropriate and chemotherapy has a role for tumor spread beyond the nasal cavity and paranasal sinuses. The current imaging modality of choice for assessment of these tumors is contrast enhanced computed tomography (CT), although magnetic resonance imaging (MRI) has a role also. This case series indicates a role for [F18]2’-fluoro-2’-deoxy-D-glucose (FDG) positron-emission tomography combined with CT (PETCT) for radiological evaluation of ONB. Materials: A retrospective review of the medical records of all patients diagnosed with ONB in Northern Ireland between 1996 and 2009 was carried out. FDG PETCT images were analyzed where available and correlation made with clinical data. Eight patients (4 male, 4 female) were included, and three of these individuals had FDG PETCT scanning. Results: FDG PETCT is an effective imaging tool for assessment of newly diagnosed ONB, recurrence of disease and distant metastases. Findings on PETCT images correlated with the clinical picture in the three cases studied. Increased FDG uptake was seen in all confirmed recurrent ONB. One case had FDG positive directed surgical management of recurrent disease on two occasions. The final FDG PETCT indicated no recurrence and the patient remains alive and disease free. The second patient presented with Kadish stage IV disease, which was positive on FDG PETCT. Response to therapy assessment with FDG PETCT was negative and the patient died approximately 12 months after treatment. The third patient also had Kadish stage IV disease which was also FDG positive, but the patient rapidly deteriorated and died eight days following PETCT scan. Conclusions: PETCT is an effective tool in the imaging of ONB. ONB tumors appear to be FDG positive and this characteristic highlights the perceived benefit of PET-CT over conventional CT imaging. 867 poster SERIAL TOMOTHERAPY BASED IMRT IN HEAD AND NECK CANCER: OUR INITIAL EXPERIENCE. D. Russo1 , A. Papaleo1 , E. Cavalera1 , A. Leone1 , M. G. Natali2 , G. Ronzino3 , A. Palumbo4 , C. Nuzzo5 , G. Pastore2 , F. Fiorica6 , M. Santantonio1 1 R ADIATION T HERAPY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 2 M EDICAL P HYSICS U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 3 O NCOLOGY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 4 OTORINILARYNGOIATRY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 5 R ADIOLOGY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 6 R ADIATION T HERAPY U NIT U NIVERSITY H OSPITAL F ERRARA, Ferrara, Italy Purpose: To investigate the feasibility and the optimization of serial tomotherapy-based IMRT in patients with head and neck cancer treated with simultaneous integrated boost technique. Materials: From November 2008 to May 2010, 13 patients with squamous cell locally advanced carcinoma of the head and neck were treated with IMRT. Patients were immobilized with a noninvasive mask and treated using a serial tomotherapy device on a 6 MV linear accelerator (Siemens Primus MD.) Treatment planning was performed on a Peacock inverse planning system and prescription optimization was used to achieve the best plan for target coverage and parotid sparing. The treatment planning system process has a dosimetric characteristic of delivering different doses to different target structures simultaneously in each daily treatment. Therefore, three different doses were delivered, 2.33 Gy , 2 Gy and 1.8 Gy daily to reach a total dose of 69.9, 60 and 53 Gy. All patients but two received concurrent chemotherapy. Results: Median follow-up was 12 months (range 1-17). All patients completed the prescribed treatment without unexpected interruption. Acute side effects were tolerable and comparable to those of patients treated with conventional beam arrangements. Only a patient required nasogastric feeding tube. The preliminary experience showed that the noninvasive immobilization
SIMULTANEOUS INTEGRATED BOOST 18FDG-PET BASED HELICAL TOMOTHERAPY IN RADICAL LOCALLY ADVANCED HEAD AND NECK CANCER. I. Dell’Oca1 , C. Fiorino2 , A. Fodor1 , A. Chiara1 , E. Villa1 , W. Casagrande1 , A. Rognone3 , M. Pasetti1 , S. Broggi2 , E. Busnardo4 , C. Landoni4 , L. Gianolli4 , R. Calandrino2 , N. Di Muzio1 1 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Department of Radiation Oncology, Milan, Italy 2 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Medical Physics, Milan, Italy 3 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Medical Oncology, Milan, Italy 4 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Department of Nuclear Medicine, Milan, Italy Purpose: To evaluate acute, late toxicity and early outcome of Helical Tomotherapy (HT) in radical locally advanced Head and Neck cancer patients treated with the Simultaneous Integrated Boost (SIB) technique with dose escalation to PET/CT positive tumor sub volumes . Materials: Sixty two patients who underwent HT for locally advanced Head and Neck cancer (stage III IV B) were prospectively evaluated. Twenty six patients were affected by Nasopharynx cancer, 27 Oropharynx, 5 Larynx, 2 Hypopharynx and 2 Oral Cavity. HT was delivered with the SIB technique at different dose levels: 69Gy (2.3 Gy/day) to the PET-positive volume, 66 Gy (2.2 Gy/day) to the clinical target volume and metastatic nodal station, 54 Gy (1.8 Gy/day) to the clinical negative neck region concomitantly. Concurrent chemotherapy was given for 46 patients (cisplatin 75-100 mg/m every three weeks, or 30 mg/m weekly for 42 patients and Cetuximab for 4 patients). Care was taken to minimize as much as possible the dose to many structures (mucosae outside PTV1, larynx, oesophagus, inner ear, thyroid, brain, lungs, sub-mandibular connective tissue, bones structures) without compromising the respect of the constraints set for PTV coverage and the remaining OARs like spinal cord, brain stem and parotids. Results: All patients completed the treatment. Fifty-five patients had Radiation Therapy Oncology Group Grade (G) 0-1 acute salivary gland toxicity while no G3 toxicity was seen. Twenty five and 21 patients had respectively G 2 and 3 acute mucositis, while 35 and 12 acute G 2 and 3 skin reactions, no G4 toxicity was seen. Six patients were lost at follow-up while for the remaining 56, with a median follow-up of 18 months (3-64), 41 were locoregionally NED, 13 patients experienced locoregional relapse while for 9 pts distant metastasis were seen. For patients with more than six months followup, no severe late toxicity was seen. Four patients experiencing taste suppression and 7 G2 salivary gland toxicity. Conclusions: These preliminary findings show that SIB-HT with dose escalation to 18FDG-PET positive tumor sub volumes is a feasible technique also when administered concurrently with chemotherapy and might also prove to be biologically more effective. Taking care in sparing normal tissues, HT allows very acceptable rates of acute toxicity while shortens the overall treatment time in radical treatment of patients with advanced head and neck cancer. Although the results are promising, a larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and toxicity. 869 poster SIMULTANEOUS INTEGRATED BOOST VOLUMETRIC MODULATED ARC THERAPY (SIB-VMAT) IN HEAD AND NECK TUMORS F. Deodato1 , S. Cilla2 , G. Macchia1 , M. Massaccesi1 , E. Ippolito1 , C. Digesù1 , P. Bonomo1 , V. Picardi1 , P. Viola3 , D. Sabatino2 , M. craus2 , V. Valentini4 , N. Cellini4 , A. Piermattei2 , A. G. Morganti1 1 U NIVERSITÀ C ATTOLICA DEL S. C UORE, Radiation Oncology, Campobasso, Italy 2 U NIVERSITÀ C ATTOLICA DEL S. C UORE, Physics Unit, Campobasso, Italy 3 U NIVERSITÀ C ATTOLICA DEL S. C UORE, Physics Unit, Roma, Italy 4 P OLICLINICO U NIVERSITARIO "AGOSTINO G EMELLI ", C ATHOLIC U NIVER SITY, Radiation Oncology, Roma, Italy
866 poster ROLE OF FDG PETCT IN DIAGNOSIS AND MANAGEMENT OF OLFACTORY NEUROBLASTOMA. P. McCloskey1 , M. Moran2 , S. Napier3 , D. Stewart4 , W. Primrose2 , S. Hughes5 1 C LINICAL O NCOLOGY, N ORTHERN I RELAND C ANCER C ENTRE , B ELFAST H EALTH AND S OCIAL C ARE T RUST,, Department of Radiation Oncology, Belfast, United Kingdom 2 N ORTHERN I RELAND R EGIONAL H EAD & N ECK S URGERY U NIT, Head Neck Surgery, Belfast, United Kingdom 3 R OYAL V ICTORIA H OSPITAL, Department of Pathology, Belfast, United Kingdom 4 N ORTHERN I RELAND C ANCER C ENTRE, Clinical Oncology, Belfast, United Kingdom 5 R OYAL V ICTORIA H OSPITAL, Department of Radiology and Nuclear Medicine, Belfast, United Kingdom
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mask yielded high positioning reproducibility for our patients. To spare the parotid gland in the proximity of the target, a fraction of the target volume may not receive the prescribed dose. In the best-achievable plan of our studied cohort, only 43% of parotid gland volumes were treated to more than 30 Gy, while an average of 7,8% of the target volume received less than 95% of the prescribed dose. This is mainly related to the steep dose gradient in the region where the target abuts the parotid gland. The inverse planning system allowed us the freedom of weighting normal tissue-sparing and target coverage to select the best-achievable plan. Local control was achieved in all, but one patients, who showed a PD after six months. Conclusions: A system for patient immobilization, setup verification, and dose optimization for head and neck cancer with parotid sparing without significantly compromising target coverage is being implemented for a tomotherapy-based IMRT plan at the Radiotherapy Division of Lecce Hospital. The initial clinical experience in tumor control is promising, and no severe adverse acute side effects have been observed. 868 poster
Purpose: Olfactory neuroblastoma (ONB) is a rare tumor of neuroectodermal origin that arises from the olfactory epithelium in the roof of the nasal cavity. The stage is highly predictive of survival and local disease has an excellent prognosis. Surgical treatment for localized disease is successful, however there is also a role for postoperative radiotherapy. Radical radiotherapy can be used if surgery is not deemed to be appropriate and chemotherapy has a role for tumor spread beyond the nasal cavity and paranasal sinuses. The current imaging modality of choice for assessment of these tumors is contrast enhanced computed tomography (CT), although magnetic resonance imaging (MRI) has a role also. This case series indicates a role for [F18]2’-fluoro-2’-deoxy-D-glucose (FDG) positron-emission tomography combined with CT (PETCT) for radiological evaluation of ONB. Materials: A retrospective review of the medical records of all patients diagnosed with ONB in Northern Ireland between 1996 and 2009 was carried out. FDG PETCT images were analyzed where available and correlation made with clinical data. Eight patients (4 male, 4 female) were included, and three of these individuals had FDG PETCT scanning. Results: FDG PETCT is an effective imaging tool for assessment of newly diagnosed ONB, recurrence of disease and distant metastases. Findings on PETCT images correlated with the clinical picture in the three cases studied. Increased FDG uptake was seen in all confirmed recurrent ONB. One case had FDG positive directed surgical management of recurrent disease on two occasions. The final FDG PETCT indicated no recurrence and the patient remains alive and disease free. The second patient presented with Kadish stage IV disease, which was positive on FDG PETCT. Response to therapy assessment with FDG PETCT was negative and the patient died approximately 12 months after treatment. The third patient also had Kadish stage IV disease which was also FDG positive, but the patient rapidly deteriorated and died eight days following PETCT scan. Conclusions: PETCT is an effective tool in the imaging of ONB. ONB tumors appear to be FDG positive and this characteristic highlights the perceived benefit of PET-CT over conventional CT imaging. 867 poster SERIAL TOMOTHERAPY BASED IMRT IN HEAD AND NECK CANCER: OUR INITIAL EXPERIENCE. D. Russo1 , A. Papaleo1 , E. Cavalera1 , A. Leone1 , M. G. Natali2 , G. Ronzino3 , A. Palumbo4 , C. Nuzzo5 , G. Pastore2 , F. Fiorica6 , M. Santantonio1 1 R ADIATION T HERAPY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 2 M EDICAL P HYSICS U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 3 O NCOLOGY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 4 OTORINILARYNGOIATRY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 5 R ADIOLOGY U NIT O SPEDALE V ITO FAZZI, Lecce, Italy 6 R ADIATION T HERAPY U NIT U NIVERSITY H OSPITAL F ERRARA, Ferrara, Italy Purpose: To investigate the feasibility and the optimization of serial tomotherapy-based IMRT in patients with head and neck cancer treated with simultaneous integrated boost technique. Materials: From November 2008 to May 2010, 13 patients with squamous cell locally advanced carcinoma of the head and neck were treated with IMRT. Patients were immobilized with a noninvasive mask and treated using a serial tomotherapy device on a 6 MV linear accelerator (Siemens Primus MD.) Treatment planning was performed on a Peacock inverse planning system and prescription optimization was used to achieve the best plan for target coverage and parotid sparing. The treatment planning system process has a dosimetric characteristic of delivering different doses to different target structures simultaneously in each daily treatment. Therefore, three different doses were delivered, 2.33 Gy , 2 Gy and 1.8 Gy daily to reach a total dose of 69.9, 60 and 53 Gy. All patients but two received concurrent chemotherapy. Results: Median follow-up was 12 months (range 1-17). All patients completed the prescribed treatment without unexpected interruption. Acute side effects were tolerable and comparable to those of patients treated with conventional beam arrangements. Only a patient required nasogastric feeding tube. The preliminary experience showed that the noninvasive immobilization
SIMULTANEOUS INTEGRATED BOOST 18FDG-PET BASED HELICAL TOMOTHERAPY IN RADICAL LOCALLY ADVANCED HEAD AND NECK CANCER. I. Dell’Oca1 , C. Fiorino2 , A. Fodor1 , A. Chiara1 , E. Villa1 , W. Casagrande1 , A. Rognone3 , M. Pasetti1 , S. Broggi2 , E. Busnardo4 , C. Landoni4 , L. Gianolli4 , R. Calandrino2 , N. Di Muzio1 1 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Department of Radiation Oncology, Milan, Italy 2 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Medical Physics, Milan, Italy 3 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Medical Oncology, Milan, Italy 4 S AN R AFFAELE S CIENTIFIC I NSTITUTE, Department of Nuclear Medicine, Milan, Italy Purpose: To evaluate acute, late toxicity and early outcome of Helical Tomotherapy (HT) in radical locally advanced Head and Neck cancer patients treated with the Simultaneous Integrated Boost (SIB) technique with dose escalation to PET/CT positive tumor sub volumes . Materials: Sixty two patients who underwent HT for locally advanced Head and Neck cancer (stage III IV B) were prospectively evaluated. Twenty six patients were affected by Nasopharynx cancer, 27 Oropharynx, 5 Larynx, 2 Hypopharynx and 2 Oral Cavity. HT was delivered with the SIB technique at different dose levels: 69Gy (2.3 Gy/day) to the PET-positive volume, 66 Gy (2.2 Gy/day) to the clinical target volume and metastatic nodal station, 54 Gy (1.8 Gy/day) to the clinical negative neck region concomitantly. Concurrent chemotherapy was given for 46 patients (cisplatin 75-100 mg/m every three weeks, or 30 mg/m weekly for 42 patients and Cetuximab for 4 patients). Care was taken to minimize as much as possible the dose to many structures (mucosae outside PTV1, larynx, oesophagus, inner ear, thyroid, brain, lungs, sub-mandibular connective tissue, bones structures) without compromising the respect of the constraints set for PTV coverage and the remaining OARs like spinal cord, brain stem and parotids. Results: All patients completed the treatment. Fifty-five patients had Radiation Therapy Oncology Group Grade (G) 0-1 acute salivary gland toxicity while no G3 toxicity was seen. Twenty five and 21 patients had respectively G 2 and 3 acute mucositis, while 35 and 12 acute G 2 and 3 skin reactions, no G4 toxicity was seen. Six patients were lost at follow-up while for the remaining 56, with a median follow-up of 18 months (3-64), 41 were locoregionally NED, 13 patients experienced locoregional relapse while for 9 pts distant metastasis were seen. For patients with more than six months followup, no severe late toxicity was seen. Four patients experiencing taste suppression and 7 G2 salivary gland toxicity. Conclusions: These preliminary findings show that SIB-HT with dose escalation to 18FDG-PET positive tumor sub volumes is a feasible technique also when administered concurrently with chemotherapy and might also prove to be biologically more effective. Taking care in sparing normal tissues, HT allows very acceptable rates of acute toxicity while shortens the overall treatment time in radical treatment of patients with advanced head and neck cancer. Although the results are promising, a larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and toxicity. 869 poster SIMULTANEOUS INTEGRATED BOOST VOLUMETRIC MODULATED ARC THERAPY (SIB-VMAT) IN HEAD AND NECK TUMORS F. Deodato1 , S. Cilla2 , G. Macchia1 , M. Massaccesi1 , E. Ippolito1 , C. Digesù1 , P. Bonomo1 , V. Picardi1 , P. Viola3 , D. Sabatino2 , M. craus2 , V. Valentini4 , N. Cellini4 , A. Piermattei2 , A. G. Morganti1 1 U NIVERSITÀ C ATTOLICA DEL S. C UORE, Radiation Oncology, Campobasso, Italy 2 U NIVERSITÀ C ATTOLICA DEL S. C UORE, Physics Unit, Campobasso, Italy 3 U NIVERSITÀ C ATTOLICA DEL S. C UORE, Physics Unit, Roma, Italy 4 P OLICLINICO U NIVERSITARIO "AGOSTINO G EMELLI ", C ATHOLIC U NIVER SITY, Radiation Oncology, Roma, Italy