Accelerated Hypofractionated Radiation vs. Standard Fractionated Radiation Concurrent with Cetuximab Chemotherapy in Locally Advanced Head and Neck Cancer (LAHNC)

Proceedings of the 51st Annual ASTRO Meeting region were significantly associated with the occurrence of oral ulcers. Then mean V50 in the 18 patients without oral ulcers was 36%, while that of the 6 patients with oral ulcers was 55% (p = 0.06); the mean V60 was 18% and 39%, respectively (p = 0.02); the mean V70 was 5% and 14%, respectively (p = 0.03); and the mean radiation dose to the oral region was 41 Gy and 49 Gy, respectively (p = 0.2). Conclusions: The observed dose-volume-effects suggest that the V60 and V70 of the oral region should be reduced as much as possible during the initial IMRT optimization to reduce the incidence of oral ulcers after treatment. Author Disclosure: R. Yoshimura, None; Y. Kagami, None; Y. Ito, None; H. Okamoto, None; N. Murakami, None; M. Morota, None; H. Mayahara, None; M. Sumi, None; J. Itami, None.

2560

Sequential Intensity Modulation Radiation Therapy for Head and Neck Cancer: The Northwestern University Experience

A. D. Bhate, N. S. Koneru, T. Thomas, J. A. Logemann, M. Gopalakrishnan, A. Rademaker, H. Pelzer, M. Agulnik, A. Mellott, B. B. Mittal Northwestern University Memorial Hospital, Chicago, IL Purpose/Objective(s): To review the Northwestern University experience with sequential intensity-modulated radiotherapy (IMRT) for the treatment of head and neck cancer. Materials/Methods: From August 2002 to December 2008, 83 patients with head and neck cancer were treated with IMRT using a sequential technique for curative intent. 13% of patients had Stage III disease and 74% had Stage IV disease. 8 patients received postoperative radiation; 6 received radiation alone; 49 received radiation and chemotherapy; 20 received surgery, radiation and chemotherapy. Sites included were larynx (14), nasopharynx (7), oral cavity (5), oropharynx (45), hypopharynx (5) and unknown primary (7). Toxicities were categorized into acute toxicity CTC, chronic worst toxicity RTOG and at last follow-up toxicity RTOG. Toxicities included skin, mucosa, dysphagia, salivary gland, mandible, larynx, pain and weight loss. Other variables included G-tube placement and esophageal stricture formation. Results: The median follow-up was 14 months. The estimated 2 year local progression free survival, distant disease free survival and overall tumor progression free survival was 91%, 85% and 82%, respectively. Acutely there was one Grade 4 mucositis and one Grade 4 pain toxicity. There was no other acute or chronic Grade 4 or 5 toxicities. Acute Grade 3 toxicities included skin 43%, mucositis 75%, dysphagia 39%, salivary gland 1%, pain 1% and weight loss 10%. Grade 3 worst chronic toxicities included skin 8%, dysphagia 18%, salivary gland 32% and weight loss 26%. Grade 3 last follow-up chronic toxicities included skin 8%, dysphagia 8%, salivary gland 13% and weight loss 18%. 17 of 83 patients (21%) had esophageal stricture of which 16 occurred prior to August 2006. We then started to reduce doses to the laryngo-pharyngeal-esophageal axis (LPEA) and since then only 1 of 42 patients had a stricture. 48% of patients required a G-tube during radiation. Conclusions: Currently in the US, IMRT using a Simultaneous Integrated Boost (SIB) technique to treat head and neck cancers is most widely used. We have used a sequential technique in order to decrease hotspots and maintain a constant fraction size. The sequential technique offers excellent tumor progression free survival with comparable toxicities to the published SIB technique. The treatment technique and dose volume histogram data on 24 normal structures contoured for each patient will be presented and correlated to the toxicity. Reduced doses to the LPEA decreased the incidence of esophageal stricture. This data supports that IMRT using a sequential technique is an option for head and neck cancer treatment. Author Disclosure: A.D. Bhate, None; N.S. Koneru, None; T. Thomas, None; J.A. Logemann, None; M. Gopalakrishnan, None; A. Rademaker, None; H. Pelzer, None; M. Agulnik, None; A. Mellott, None; B.B. Mittal, None.

2561

Accelerated Hypofractionated Radiation vs. Standard Fractionated Radiation Concurrent with Cetuximab Chemotherapy in Locally Advanced Head and Neck Cancer (LAHNC)

S. L. Galper1, H. Deshpande2, M. G. Rose3, J. Colasanto4, R. Decker1 Yale University School of Medicine, New Haven, CT, 2Yale Cancer Center, New Haven, CT, 3VA Cancer Center, West Haven, CT, 4St Francis Hospital, Hartford, CT

1

Purpose/Objective(s): Concurrent chemoradiation with cetuximab improves survival with acceptable toxicity in patients being treated for LAHNC. Accelerated fractionation has been shown to improve local-regional control (LRC), but is associated with increased toxicity. The purpose of this study is to compare our experience with accelerated hypofractionation with concurrent cetuximab (HFRT) to standard fractionation with cetuximab (SFRT). Materials/Methods: We reviewed the records for patients treated with curative chemoradiation therapy between January 2005 and December 2008. During that period, cetuximab concurrent chemoradiotherapy was administered in 14 patients whose age or comorbidities precluded cisplatin-based chemotherapy. 8 received HFRT with greater than 2 Gy/day (median 2.2 Gy/day) and 6 received SFRT with 2 Gy/day. Patient charts and Tumor Registry data were reviewed for acute and late toxicity, which were scored by RTOG criteria, and for local/regional failure (LRF), distant metastases and death. Results: The cohorts were balanced for age (median age 71 vs. 66, p = 0.18) and AJCC stage. The hypofractionated cohort had more oropharynx primaries (25% vs. 0%) and fewer larynx/hypopharynx primaries (38% vs. 50%). 2 patients in each group received postoperative radiation instead of definitive radiation. Median follow-up times for the HFRT and SFRT cohorts were 10 and 16 months, respectively (p = 0.08). Overall treatment time in the HFRT cohort patients was shorter (45 days vs. 52 days, p = 0.002). Acneiform rash was reported in 50% and 67% of the HFRT and SFRT cohorts, respectively. Average weight loss was similar, 13lbs in the HFRT cohort and 10 lb in the SFRT cohort (p = NS). Grade 3 acute toxicity was observed in 3/8 patients in HFRT arm, and 3/6 patients in SFRT arm (p = NS). No Grade 4 or greater acute toxicities occurred in either arm. No Grade 3 or greater late toxicities were reported in either cohort. There was no significant difference in 2 year LRC (36% and 40%) or 2 year overall survival (80% in the HFRT cohort and 75% in the SFRT cohort).

S433

I. J. Radiation Oncology d Biology d Physics

S434

Volume 75, Number 3, Supplement, 2009

Conclusions: In this small series, HFRT with concurrent cetuximab was well-tolerated and not significantly more toxic than SFRT with cetuximab. Given the known improvement in LRC with accelerated fractionation, HFRT concurrent with cetuximab represents a reasonable treatment strategy. Author Disclosure: S.L. Galper, None; H. Deshpande, None; M.G. Rose, None; J. Colasanto, None; R. Decker, None.

2562

Organ Preservation using HDR Brachytherapy for Locally Advanced Head and Neck Cancers: A Single Center Experience

M. Duclos1, A. Al-Hamad1, H. Al-Halabi1, A. Alsuhaibani1, K. Kost1, A. Zeitouni1, M. Hier2, G. Shenouda1, M. Black2 1

Montreal General Hospital, Montreal, Qc, Canada, 2jewish General Hospital, Montreal, Qc, Canada

Purpose/Objective(s): Head and neck cancer treatment is challenging. The ultimate goal is to offer loco-regional control with the minimal long-term toxicity. HDR brachytherapy as a boost or single treatment modality can be used in a primary setting or as a salvage modality treatment. Materials/Methods: Between June 1994 and December 2006, 71 patients underwent conservative surgery followed by HDR brachytherapy treatment as part of their initial treatment. The dose varies from 30–36 Gy/10–12 fx BID, for solo adjuvant treatment, to 15–21 Gy/5–7 tx BID for a boost. The oral cavity represent 77% of our patients (55): oral tongue (35), floor of mouth (11) and gingiva (9). The remaining patients presented with base of tongue primary (16). 44 patients received HDR brachytherapy as a boost (13) or single modality adjuvant treatment (31). 27 were treated in a salvage manner either as a boost (6) or single treatment (21). The TNM staging revealed that 28.2% were Stage 2, 64.7% Stage 3 and 7% Stage 4. Chemotherapy was given in all patients with base of tongue primaries. Results: With a median follow-up of 48 months (24 to 120) and a median age of 67 years, 5 patients died (2 from disease progression). The overall local control rate was 60.5%: 70.5% for patients treated as part of their primary treatment and 40.7% in recurrent setting. 5.6% developed acute toxicity. 29.6% developed G1–2 and 7.1% G3 late toxicity. Conclusions: Treatment of head and neck cancer implies a multidisciplinary approach. Adjuvant HDR brachytherapy increase the local control with minimal toxicity. Author Disclosure: M. Duclos, None; A. Al-Hamad, None; H. Al-Halabi, None; A. Alsuhaibani, None; K. Kost, None; A. Zeitouni, None; M. Hier, None; G. Shenouda, None; M. Black, None.

2563

Results of Radiotherapy for Esthesioneuroblastoma: Is Elective Nodal Irradiation Warranted?

O. Noh, S. Yoon, S. Kim, B. Lee, C. Kim, K. Jo, E. Choi, J. Kim, S. Ahn, S. Lee, et al. Asan Medical Center, Seoul, Republic of Korea Purpose/Objective(s): The role of elective nodal irradiation (ENI) in radiotherapy for esthesioneuroblastoma (ENB) is not clearly defined. In our institution, ENI has not been performed routinely in radiotherapy (RT) of ENB. We analyzed the treatment outcome of the ENB and the rate of the cervical nodal failure in the absence of the ENI. Materials/Methods: Between August 1996 and December 2007, 19 patients with ENB were consulted for RT. Fourteen patients (74%) were male and median age was 40 years (range, 5–70). The modified Kadish Stage was A in 1, B in 4, C in 6, and D in 8. Initial treatment included surgery alone in 3, surgery and postoperative RT in 4, surgery and adjuvant chemotherapy in 1, surgery, postoperative RT and chemotherapy in 3, chemotherapy followed by RT or CCRT in 5. Three patients did not receive the planned treatment due to disease progression. Including 2 patients with salvage RT, 14 patients received radiotherapy. ENI was performed in 4 patients in high-risk patients. Of theses, 3 patients had cervical lymph node metastasis at presentation. Results: Fourteen patients were analyzable and median follow-up time was 24 months (range, 7–64). Overall survival rate at 3 year was 64.9%. Local failure was shown in 3 (21%), regional cervical failure in 3 (21%) and distant failure in 2 (14%). No cervical failure occurred in patients with combined chemotherapy regardless of ENI. Three cervical failures occurred in 4 patients with ENI or neck dissection (75%) and all these patients did not received combined chemotherapy. Conclusions: Elective nodal irradiation in RT for ENB seems to be ineffective to prevent cervical failure in patients treated with chemotherapy combined multimodality therapy. Author Disclosure: O. Noh, None; S. Yoon, None; S. Kim, None; B. Lee, None; C. Kim, None; K. Jo, None; E. Choi, None; J. Kim, None; S. Ahn, None; S. Lee, None.

2564

A Century of Total Body Irradiation (TBI)

C. A. Barker, A. Rimner, J. Yahalom Memorial Sloan-Kettering Cancer Center, New York, NY Purpose/Objective(s): To review the world literature and experience with TBI over the last century, summarizing major contributions, advances and controversies involving the technique. Materials/Methods: The ISI Web of Knowledge electronic database was searched for the terms ‘‘total body irradiation’’ or ‘‘whole body irradiation.’’ Bibliographic references from the oldest and most highly cited studies were used to create a timeline detailing the development of the technique over the last 100 years. Results: The literature search revealed 16,636 studies. In 1905, Friedrich Dessauer first described TBI using 3 simultaneously active low voltage X-ray sources to treat a supine patient, and later that year, Aladar Elfer reported the first clinical data using the technique. In 1925, Werner Teschendorf began a TBI program in Cologne for the treatment of lymphoid and hematopoietic