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877 poster TOLERABILITY OF SEQUENTIAL CHEMORADIATION FOR HEAD AND NECK CANCER PATIENTS OUTSIDE A CLINICAL TRIAL
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H EAD N ECK CANCER
distribution. Seventy patients continued to the most risk area up to a dose of 60 Gy and three (exclusive RT) reached 70 Gy . Results: Homogenous dose to CTV ranging from 85 % to 109 % of prescribed dose, was achieved. The dose to spinal chord lay from 40 to 45 Gy.The treatment was always completed. Only one patient got a week of suspension after 4 fractions caused by an infection. Acute side effects of the treatment were moderate. All patients had a grade 1- 2 dermatological toxicity and only 2 grade 3 (Cetuximab patient). Dysphagia was mainly grade 2 in "only RT" and more severe (grade 3) in "concomitant therapy". Four patients with concomitant chemotherapy got mucositis of grade 3 and the other got mucositis of grade 2. Salivary change of grade 2 was reported in all patients. At the moment only two patien with bilateral neck dissection devolope a neck linphedema. Among all patients, ,only tree suffered from a local recurrence (two laryngeal ca. N2 no chemotherapy and a tongue N2).
Conclusions: Subclinical hypothyroidism is important sequelae seen in the treated patients of head and neck when thyroid is in the radiation field. The patients with age less than 41 years are more prone to develop hypothyroidism. Chemotherapy has not affected the incidence of hypothyroidism significantly. Also, the dose of radiation has not shown any statistically significant difference. 877 poster TOLERABILITY OF SEQUENTIAL CHEMORADIATION FOR HEAD AND NECK CANCER PATIENTS OUTSIDE A CLINICAL TRIAL T. Roques1 , K. Geropantas2 , Z. Tasigiannopoulos2 , S. Loo2 , C. Martin2 1
N ORFOLK AND N ORWICH U NIVERSITY H OSPITAL NHS T RUST, Clinical Oncology, Norwich, United Kingdom N ORFOLK AND N ORWICH U NIVERSITY H OSPITAL NHS T RUST, Norwich, United Kingdom
2
Conclusions: This technique for 3DCRT seemes routinely feasible and associated with moderate acute toxicity and thanks to the isocentric set up requires an easy and unique initial positioning to perform the entire treatment .Moreover it gives the possibility to raise the dose to the neck up to 54 Gy. 876 poster THYROID DISEASES AS A SEQUELAE FOLLOWING TREATMENT OF HEAD AND NECK CANCER R. P. S. Banipal1 , M. K. Mahajan1 , B. Uppal2 , M. John3 1 C HRISTIAN M EDICAL C OLLEGE AND H OSPITAL, Department of Radiotherapy, Ludhiana, India 2 C HRISTIAN M EDICAL C OLLEGE AND H OSPITAL, Department of Biochemistry, Ludhiana, India 3 C HRISTIAN M EDICAL C OLLEGE AND H OSPITAL, Department of Medicine, Ludhiana, India
Purpose: To evaluate the radiation induced sequelae on thyroid gland and influence of concomitant chemotherapy. Materials: This prospective study was carried out on 53 patients of head and neck carcinoma in the age group of 30 75 years (55.9 years). Patients were treated with external beam radiotherapy (52.8%) or concurrent chemoradiotherapy with 5-flourouracil and cisplatinum (47.1%). The target volume included the thyroid gland, which received an average dose of 60 Gy in 30 fractions. Thyroid function tests were done at the start of radiotherapy. Follow up thyroid function tests were done on completion of radiotherapy treatment, at 3 months, at 6 months after treatment, and then every 6 months. Follow up ranges from 3 - 51 months (median - 27 months). Results: Subclinical hypothyroidism was seen in 4 (7.5%) of the 53 patients. In three patients the incidence was seen after a gap of 12 months and in one patient after a gap of 35 months. Of the four patients, three were of age ≤ 41 years and 1 was of age 66 years. In younger age group (3039 years) patients, TSH shows statistically significant (P<0.05) increase in TSH values(Image). No significant difference was observed in radiation and chemo-radiation treatment groups. (P>0.10)
Purpose: We routinely use sequential cisplatin/5-fluorouracil (PF) induction chemotherapy and radical radiotherapy with concomitant weekly carboplatin (SCRT) in the management of patients with locoregionally advanced HNSCC. The aim of this study is to assess the tolerability of PF induction chemotherapy and whether it may compromise delivery of the subsequent radiochemotherapy. Materials: The SCRT protocol in our department comprises up to 3 cycles of PF induction chemotherapy with cisplatin 100mg/m2 on day 1 combined with continuous infusion 5-fluorouracil 1000mg/m2 /day days 1-5 administered every 21 days. This is followed by curative RT with or without concomitant weekly carboplatin 100mg/m2 . We analyzed 190 consecutive patients treated with SCRT between March 2003 and May 2010. Results: There were 144 males and 46 females. Median age was 60 years. 42 patients (22%) were older than 70 years. Primary tumour sites were as follows: oropharynx - 123, larynx - 17, hypopharynx - 15, nasopharynx - 8, oral cavity - 7, nasal cavity - 2 and unknown upper aerodigestive tract primary - 18. 78% completed all planned cycles of PF. 15% and 7% of patients had one and two cycles of PF omitted respectively. 28% required PF dose reduction and 19% a change of chemotherapy from cisplatin to carboplatin. Two patients (1%) died after the first cycle of PF as a result of neutropenic sepsis. 7.4% required hospitalization for PF-related toxicities. Median time from the first cycle of induction chemotherapy until start of radiotherapy was 72 days. Serum haemoglobin was compared before first cycle of induction chemotherapy and before start of radiotherapy and a reduction was seen in 87% of patients (mean fall of 2.5g/dl). 25% required a blood transfusion during either induction or concomitant chemotherapy. 95% of patients completed radiotherapy as prescribed. 2.5% did not complete RT whilst RT treatment duration was prolonged by more than two days in another 2.5%. In 63% of patients no more than one cycle of concomitant chemotherapy was missed, but 18% did not receive any concomitant chemotherapy with their RT. Conclusions: PF induction chemotherapy in HNSCC can be delivered without compromising subsequent RT in almost all patients. A significant number of patients do not complete all planned cycles of concomitant chemotherapy but it is unclear whether this is due to the induction chemotherapy alone. Concerns remain over the significant number of patients who experience a drop in their serum haemoglobin levels from PF. The impact of this on hypoxia and therefore on tumour control remains unknown.
H EAD N ECK CANCER
distribution. Seventy patients continued to the most risk area up to a dose of 60 Gy and three (exclusive RT) reached 70 Gy . Results: Homogenous dose to CTV ranging from 85 % to 109 % of prescribed dose, was achieved. The dose to spinal chord lay from 40 to 45 Gy.The treatment was always completed. Only one patient got a week of suspension after 4 fractions caused by an infection. Acute side effects of the treatment were moderate. All patients had a grade 1- 2 dermatological toxicity and only 2 grade 3 (Cetuximab patient). Dysphagia was mainly grade 2 in "only RT" and more severe (grade 3) in "concomitant therapy". Four patients with concomitant chemotherapy got mucositis of grade 3 and the other got mucositis of grade 2. Salivary change of grade 2 was reported in all patients. At the moment only two patien with bilateral neck dissection devolope a neck linphedema. Among all patients, ,only tree suffered from a local recurrence (two laryngeal ca. N2 no chemotherapy and a tongue N2).
Conclusions: Subclinical hypothyroidism is important sequelae seen in the treated patients of head and neck when thyroid is in the radiation field. The patients with age less than 41 years are more prone to develop hypothyroidism. Chemotherapy has not affected the incidence of hypothyroidism significantly. Also, the dose of radiation has not shown any statistically significant difference. 877 poster TOLERABILITY OF SEQUENTIAL CHEMORADIATION FOR HEAD AND NECK CANCER PATIENTS OUTSIDE A CLINICAL TRIAL T. Roques1 , K. Geropantas2 , Z. Tasigiannopoulos2 , S. Loo2 , C. Martin2 1
N ORFOLK AND N ORWICH U NIVERSITY H OSPITAL NHS T RUST, Clinical Oncology, Norwich, United Kingdom N ORFOLK AND N ORWICH U NIVERSITY H OSPITAL NHS T RUST, Norwich, United Kingdom
2
Conclusions: This technique for 3DCRT seemes routinely feasible and associated with moderate acute toxicity and thanks to the isocentric set up requires an easy and unique initial positioning to perform the entire treatment .Moreover it gives the possibility to raise the dose to the neck up to 54 Gy. 876 poster THYROID DISEASES AS A SEQUELAE FOLLOWING TREATMENT OF HEAD AND NECK CANCER R. P. S. Banipal1 , M. K. Mahajan1 , B. Uppal2 , M. John3 1 C HRISTIAN M EDICAL C OLLEGE AND H OSPITAL, Department of Radiotherapy, Ludhiana, India 2 C HRISTIAN M EDICAL C OLLEGE AND H OSPITAL, Department of Biochemistry, Ludhiana, India 3 C HRISTIAN M EDICAL C OLLEGE AND H OSPITAL, Department of Medicine, Ludhiana, India
Purpose: To evaluate the radiation induced sequelae on thyroid gland and influence of concomitant chemotherapy. Materials: This prospective study was carried out on 53 patients of head and neck carcinoma in the age group of 30 75 years (55.9 years). Patients were treated with external beam radiotherapy (52.8%) or concurrent chemoradiotherapy with 5-flourouracil and cisplatinum (47.1%). The target volume included the thyroid gland, which received an average dose of 60 Gy in 30 fractions. Thyroid function tests were done at the start of radiotherapy. Follow up thyroid function tests were done on completion of radiotherapy treatment, at 3 months, at 6 months after treatment, and then every 6 months. Follow up ranges from 3 - 51 months (median - 27 months). Results: Subclinical hypothyroidism was seen in 4 (7.5%) of the 53 patients. In three patients the incidence was seen after a gap of 12 months and in one patient after a gap of 35 months. Of the four patients, three were of age ≤ 41 years and 1 was of age 66 years. In younger age group (3039 years) patients, TSH shows statistically significant (P<0.05) increase in TSH values(Image). No significant difference was observed in radiation and chemo-radiation treatment groups. (P>0.10)
Purpose: We routinely use sequential cisplatin/5-fluorouracil (PF) induction chemotherapy and radical radiotherapy with concomitant weekly carboplatin (SCRT) in the management of patients with locoregionally advanced HNSCC. The aim of this study is to assess the tolerability of PF induction chemotherapy and whether it may compromise delivery of the subsequent radiochemotherapy. Materials: The SCRT protocol in our department comprises up to 3 cycles of PF induction chemotherapy with cisplatin 100mg/m2 on day 1 combined with continuous infusion 5-fluorouracil 1000mg/m2 /day days 1-5 administered every 21 days. This is followed by curative RT with or without concomitant weekly carboplatin 100mg/m2 . We analyzed 190 consecutive patients treated with SCRT between March 2003 and May 2010. Results: There were 144 males and 46 females. Median age was 60 years. 42 patients (22%) were older than 70 years. Primary tumour sites were as follows: oropharynx - 123, larynx - 17, hypopharynx - 15, nasopharynx - 8, oral cavity - 7, nasal cavity - 2 and unknown upper aerodigestive tract primary - 18. 78% completed all planned cycles of PF. 15% and 7% of patients had one and two cycles of PF omitted respectively. 28% required PF dose reduction and 19% a change of chemotherapy from cisplatin to carboplatin. Two patients (1%) died after the first cycle of PF as a result of neutropenic sepsis. 7.4% required hospitalization for PF-related toxicities. Median time from the first cycle of induction chemotherapy until start of radiotherapy was 72 days. Serum haemoglobin was compared before first cycle of induction chemotherapy and before start of radiotherapy and a reduction was seen in 87% of patients (mean fall of 2.5g/dl). 25% required a blood transfusion during either induction or concomitant chemotherapy. 95% of patients completed radiotherapy as prescribed. 2.5% did not complete RT whilst RT treatment duration was prolonged by more than two days in another 2.5%. In 63% of patients no more than one cycle of concomitant chemotherapy was missed, but 18% did not receive any concomitant chemotherapy with their RT. Conclusions: PF induction chemotherapy in HNSCC can be delivered without compromising subsequent RT in almost all patients. A significant number of patients do not complete all planned cycles of concomitant chemotherapy but it is unclear whether this is due to the induction chemotherapy alone. Concerns remain over the significant number of patients who experience a drop in their serum haemoglobin levels from PF. The impact of this on hypoxia and therefore on tumour control remains unknown.