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A New and Precise Method for Quantitative Detecting Cell Free EBV-DNA in the Plasma of Patients With Nasopharyngeal Carcinoma
Poster Viewing E353
Volume 96 Number 2S Supplement 2016 Purpose/Objective(s): To evaluate the site of nodal failure (NF) of nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT). Materials/Methods: We retrospectively reviewed the records of the 165 patients with pathologically confirmed, non-metastatic NPC treated with IMRT between July 1998 and April 2011 at our institution. Recurrent nodes were delineated on diagnostic imaging and co-registered with the original treatment planning computed tomography (CT). The failure was assessed as in-field, out-field or marginal based on the relative volumes of the recurrent nodes covered by the original dose distribution. The distribution of the recurrent nodes was then documented according to the cervical nodal levels. Results: Ten patients had NF at a median follow-up of 70.4 months for surviving patients. The 3 and 5 year overall survival (OS) and NF rates were 88.7%, 76.0% and 5.8%, 7.7%, respectively. Of the 10 patients with nodal recurrences, 5 had synchronous local failure (LF), 1 had synchronous local and distant recurrences and 4 had NF as their first site of failure. Six of the nodal failures were in-field–of which 5 were in level II; whereas 4 had out-field failures, all of which were in the protected parotid gland area. Conversely, there were no recurrences in level 1b despite this region being protected in the majority of treated patients. The cumulative 3 and 5 year failure rates in the parotid gland area were 2.2% and 3.1%. All patients with nodal failures in the parotid gland area had extensive nodal metastases before treatment and 3 patients initially had subcentimeter, non-specific nodules in the same locations of the parotid gland as the recurrent nodes. Conclusion: Nodal failure is uncommon after IMRT in NPC. In-field level II is the most common site of nodal recurrence whereas the parotid gland region accounts for all of the out-field failures and 40% of NF in our study. Comprehensive imaging and assessment of nodules in or around parotid gland is therefore a key aspect of treatment planning and follow up– particularly for patients with extensive lymphatic involvement. Author Disclosure: Q. LaPlant: None. J. Li: None. P. Venigalla: None. J.E. Leeman: None. J. Setton: None. E.J. Sherman: None. D.S. Higginson: None. S. McBride: None. N. Riaz: None. N. Lee: None. C. Tsai: None.
2869 A New and Precise Method for Quantitative Detecting Cell Free EBVDNA in the Plasma of Patients With Nasopharyngeal Carcinoma Q. Lin1 and B. HU2; 1The Fist Affiliated Hospital of Xiamen University Xiamen, China, 2The First Affiliated Hospital of Xiamen University, Xiamen, China Purpose/Objective(s): To construct a new method for quantitative detecting cell free EBV-DNA in the plasma of patients with Nasopharyngeal Carcinoma (NPC) and to illustrate its diagnostic value. Materials/Methods: 86 primary patients with NPC and 25 healthy people as normal controls were enrolled into the study between April and December 2015. All plasma samples from the patients with NPC and controls were detected by quantitative Real-Time PCR after treating with nucleic acid releasing agent or Circulating Nucleic Acid Extraction kit. Results: Cell free EBV-DNA (samples treated with Circulating Nucleic Acid Extraction kit) level and detecting rate (2170IU/ml, 89%) in patients with NPC were significantly higher than that in normal controls (0 IU/ml, 5%) (P< 0.05), and the ratio varied from10% to 90% in total EBV-DNA (samples treated with Surfactin) in plasma of NPC patients. Cell free EBVDNA level was significantly increased in TNM stage I (1510 IU/ml), II (42 380 IU/ml), III (75 600 IU/ml) and IV (367 900 IU/ml) in NPC patients. Conclusion: An accurate and new quantitative Real-Time PCR method for detecting cell free EBV-DNA in the plasma of NPC patients is constructed successfully. With this method we find that cell free EBV-DNA is a sensitive and specific biomarker for NPC. Author Disclosure: Q. Lin: Research Grant; Youth science fund project of Chinese National Natural Science Fund, The projects of Xiamen Science and Technology Bureau. B. HU: None.
2870 Outcome of Radiation Therapy for Aggressive Basal Cell Carcinoma of the Head and Neck A. Rishi,1 S.H. Huang,1 Y. Song,2 J.N. Waldron,1 B. O’Sullivan,1 W. Wells,1 J.G. Ringash,1 A. Sun,1 A.J. Hope,1 P. Chung,1 M.E. Giuliani,1 D. Goldstein,3 A. Spreafico,4 L. Tong,1 W. Xu,2 and A. Bayley1; 1 Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 3Department of Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 4Department of Medical Oncology, Princess Margaret Cancer Centre / University of Toronto., Toronto, ON, Canada Purpose/Objective(s): Head and neck basal cell carcinoma (HN-BCC) is primarily managed with surgery. Radiation therapy (RT) is sometimes used postoperatively (PORT) for aggressive BCC with adverse pathological features to enhance loco-regional control (LRC) or as a surgical alternative. This study reviews outcome of HN-BCC following mega-voltage RT in our institution. Materials/Methods: All aggressive type HN-BCC (primary lesion >1 cm in diameter, history of >2 recurrences, or extra-cutaneous extension), who received definitive or PORT between 1998 and 2014 were reviewed. Locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were calculated for all cases and for cases who received definitive RT. Univariate analysis (UVA) was done to examine the association of tumor factors and LRC. Results: A total of 111 consecutive HN-BCC cases were identified including 71 newly diagnosed and 40 recurrent BCC (rBCC). Median age was 76 years. Aggressive features included: initial lesion >1 cm in diameter (n Z 109), >2 prior recurrences (n Z 24), or extra-cutaneous extension (n Z 30). Definitive RT (45-70 Gy at 1.8-4.5 Gy per fraction) was given in 73 (65.7%) cases for the following reasons: technically not suited for surgery (n Z 20), cosmetic consideration (n Z 42), and high operative risk due to age or comorbidities (n Z 11). PORT (50-66 Gy at 1.8-2 Gy per fraction) was given in 38 cases for either adverse pathological features (compromised margins, deep invasion, and positive lymph nodes) (n Z 26/38) or history of multiple recurrences (n Z 14/38). Chemotherapy was used in only 6 (5.4%) patients. Median follow-up duration was 4.7 years. At 5 years, LRC, RFS, and OS were 87%, 82%, and 93% for the entire cohort and 85%, 82%, and 96% for the definitive RT subset, respectively. UVA revealed that rBCC [hazard ratio (HR) 8.03 (95% CI: 1.04-61.9), P Z 0.04], primary arising from peri-orbital/peri-auricular region [HR 0.03 (1.06-9.13), P Z 0.05], tumor size [HR 1.32 (1.08-1.61), P<0.01], lymph node involvement (N+) [HR 3.7 (1.11-12.3), P Z 0.03] and Stage III/IV [HR 3.16 (1.19-8.36), P Z 0.03] were associated with increased risk of loco-regional recurrence. Tumor size [HR 1.23 (1.021.47), P Z 0.02] and N+ [HR 4.84 (1.57-14.95), P<0.01] had a significantly worse OS. Conclusion: This study shows that RT achieves a high LRC when used as single modality or as PORT. Recurrent tumor, size, nodal involvement and stage are associated with increased risk of recurrence. Author Disclosure: A. Rishi: None. S. Huang: Travel Expenses; Elekta Inc. Y. Song: None. J.N. Waldron: None. B. O’Sullivan: None. W. Wells: None. J.G. Ringash: None. A. Sun: None. A.J. Hope: None. P. Chung: None. M.E. Giuliani: Travel Expenses; Elekta Inc. D. Goldstein: None. A. Spreafico: None. L. Tong: None. W. Xu: None. A. Bayley: None.
2871 Efficacy and Toxicity of Intensity Modulated Carbon Ion Radiation Therapy for Local Recurrent Nasopharyngeal Cancer L. Kong,1,2 L. Wang,3 X. Guan,2 J. Hu,2 J. Gao,2 X. Zhang,1,2 Y. Zhu,1,2 and J.J. Lu2; 1Fudan University Shanghai Cancer Center, Shanghai, China, 2Shanghai Proton and Heavy Ion Center (SPHIC), Shanghai, China, 3Second Hospital of Kashi, Xinjiang, China
Volume 96 Number 2S Supplement 2016 Purpose/Objective(s): To evaluate the site of nodal failure (NF) of nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy (IMRT). Materials/Methods: We retrospectively reviewed the records of the 165 patients with pathologically confirmed, non-metastatic NPC treated with IMRT between July 1998 and April 2011 at our institution. Recurrent nodes were delineated on diagnostic imaging and co-registered with the original treatment planning computed tomography (CT). The failure was assessed as in-field, out-field or marginal based on the relative volumes of the recurrent nodes covered by the original dose distribution. The distribution of the recurrent nodes was then documented according to the cervical nodal levels. Results: Ten patients had NF at a median follow-up of 70.4 months for surviving patients. The 3 and 5 year overall survival (OS) and NF rates were 88.7%, 76.0% and 5.8%, 7.7%, respectively. Of the 10 patients with nodal recurrences, 5 had synchronous local failure (LF), 1 had synchronous local and distant recurrences and 4 had NF as their first site of failure. Six of the nodal failures were in-field–of which 5 were in level II; whereas 4 had out-field failures, all of which were in the protected parotid gland area. Conversely, there were no recurrences in level 1b despite this region being protected in the majority of treated patients. The cumulative 3 and 5 year failure rates in the parotid gland area were 2.2% and 3.1%. All patients with nodal failures in the parotid gland area had extensive nodal metastases before treatment and 3 patients initially had subcentimeter, non-specific nodules in the same locations of the parotid gland as the recurrent nodes. Conclusion: Nodal failure is uncommon after IMRT in NPC. In-field level II is the most common site of nodal recurrence whereas the parotid gland region accounts for all of the out-field failures and 40% of NF in our study. Comprehensive imaging and assessment of nodules in or around parotid gland is therefore a key aspect of treatment planning and follow up– particularly for patients with extensive lymphatic involvement. Author Disclosure: Q. LaPlant: None. J. Li: None. P. Venigalla: None. J.E. Leeman: None. J. Setton: None. E.J. Sherman: None. D.S. Higginson: None. S. McBride: None. N. Riaz: None. N. Lee: None. C. Tsai: None.
2869 A New and Precise Method for Quantitative Detecting Cell Free EBVDNA in the Plasma of Patients With Nasopharyngeal Carcinoma Q. Lin1 and B. HU2; 1The Fist Affiliated Hospital of Xiamen University Xiamen, China, 2The First Affiliated Hospital of Xiamen University, Xiamen, China Purpose/Objective(s): To construct a new method for quantitative detecting cell free EBV-DNA in the plasma of patients with Nasopharyngeal Carcinoma (NPC) and to illustrate its diagnostic value. Materials/Methods: 86 primary patients with NPC and 25 healthy people as normal controls were enrolled into the study between April and December 2015. All plasma samples from the patients with NPC and controls were detected by quantitative Real-Time PCR after treating with nucleic acid releasing agent or Circulating Nucleic Acid Extraction kit. Results: Cell free EBV-DNA (samples treated with Circulating Nucleic Acid Extraction kit) level and detecting rate (2170IU/ml, 89%) in patients with NPC were significantly higher than that in normal controls (0 IU/ml, 5%) (P< 0.05), and the ratio varied from10% to 90% in total EBV-DNA (samples treated with Surfactin) in plasma of NPC patients. Cell free EBVDNA level was significantly increased in TNM stage I (1510 IU/ml), II (42 380 IU/ml), III (75 600 IU/ml) and IV (367 900 IU/ml) in NPC patients. Conclusion: An accurate and new quantitative Real-Time PCR method for detecting cell free EBV-DNA in the plasma of NPC patients is constructed successfully. With this method we find that cell free EBV-DNA is a sensitive and specific biomarker for NPC. Author Disclosure: Q. Lin: Research Grant; Youth science fund project of Chinese National Natural Science Fund, The projects of Xiamen Science and Technology Bureau. B. HU: None.
2870 Outcome of Radiation Therapy for Aggressive Basal Cell Carcinoma of the Head and Neck A. Rishi,1 S.H. Huang,1 Y. Song,2 J.N. Waldron,1 B. O’Sullivan,1 W. Wells,1 J.G. Ringash,1 A. Sun,1 A.J. Hope,1 P. Chung,1 M.E. Giuliani,1 D. Goldstein,3 A. Spreafico,4 L. Tong,1 W. Xu,2 and A. Bayley1; 1 Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 2Department of Biostatistics, Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 3Department of Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, ON, Canada, 4Department of Medical Oncology, Princess Margaret Cancer Centre / University of Toronto., Toronto, ON, Canada Purpose/Objective(s): Head and neck basal cell carcinoma (HN-BCC) is primarily managed with surgery. Radiation therapy (RT) is sometimes used postoperatively (PORT) for aggressive BCC with adverse pathological features to enhance loco-regional control (LRC) or as a surgical alternative. This study reviews outcome of HN-BCC following mega-voltage RT in our institution. Materials/Methods: All aggressive type HN-BCC (primary lesion >1 cm in diameter, history of >2 recurrences, or extra-cutaneous extension), who received definitive or PORT between 1998 and 2014 were reviewed. Locoregional control (LRC), recurrence-free survival (RFS), and overall survival (OS) were calculated for all cases and for cases who received definitive RT. Univariate analysis (UVA) was done to examine the association of tumor factors and LRC. Results: A total of 111 consecutive HN-BCC cases were identified including 71 newly diagnosed and 40 recurrent BCC (rBCC). Median age was 76 years. Aggressive features included: initial lesion >1 cm in diameter (n Z 109), >2 prior recurrences (n Z 24), or extra-cutaneous extension (n Z 30). Definitive RT (45-70 Gy at 1.8-4.5 Gy per fraction) was given in 73 (65.7%) cases for the following reasons: technically not suited for surgery (n Z 20), cosmetic consideration (n Z 42), and high operative risk due to age or comorbidities (n Z 11). PORT (50-66 Gy at 1.8-2 Gy per fraction) was given in 38 cases for either adverse pathological features (compromised margins, deep invasion, and positive lymph nodes) (n Z 26/38) or history of multiple recurrences (n Z 14/38). Chemotherapy was used in only 6 (5.4%) patients. Median follow-up duration was 4.7 years. At 5 years, LRC, RFS, and OS were 87%, 82%, and 93% for the entire cohort and 85%, 82%, and 96% for the definitive RT subset, respectively. UVA revealed that rBCC [hazard ratio (HR) 8.03 (95% CI: 1.04-61.9), P Z 0.04], primary arising from peri-orbital/peri-auricular region [HR 0.03 (1.06-9.13), P Z 0.05], tumor size [HR 1.32 (1.08-1.61), P<0.01], lymph node involvement (N+) [HR 3.7 (1.11-12.3), P Z 0.03] and Stage III/IV [HR 3.16 (1.19-8.36), P Z 0.03] were associated with increased risk of loco-regional recurrence. Tumor size [HR 1.23 (1.021.47), P Z 0.02] and N+ [HR 4.84 (1.57-14.95), P<0.01] had a significantly worse OS. Conclusion: This study shows that RT achieves a high LRC when used as single modality or as PORT. Recurrent tumor, size, nodal involvement and stage are associated with increased risk of recurrence. Author Disclosure: A. Rishi: None. S. Huang: Travel Expenses; Elekta Inc. Y. Song: None. J.N. Waldron: None. B. O’Sullivan: None. W. Wells: None. J.G. Ringash: None. A. Sun: None. A.J. Hope: None. P. Chung: None. M.E. Giuliani: Travel Expenses; Elekta Inc. D. Goldstein: None. A. Spreafico: None. L. Tong: None. W. Xu: None. A. Bayley: None.
2871 Efficacy and Toxicity of Intensity Modulated Carbon Ion Radiation Therapy for Local Recurrent Nasopharyngeal Cancer L. Kong,1,2 L. Wang,3 X. Guan,2 J. Hu,2 J. Gao,2 X. Zhang,1,2 Y. Zhu,1,2 and J.J. Lu2; 1Fudan University Shanghai Cancer Center, Shanghai, China, 2Shanghai Proton and Heavy Ion Center (SPHIC), Shanghai, China, 3Second Hospital of Kashi, Xinjiang, China