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Adaptive Radiation Therapy in Adults With Nasopharyngeal Carcinoma: A Retrospective Study at 1 Institution
Volume 94 Number 4 2016
184 Magnitude and Timing of Gross Tumor Volume Response to Neoadjuvant Chemotherapy and Concurrent Chemoradiation in the Treatment of Locally Advanced Nasopharyngeal Carcinoma J.A. Giambattista,1 N. McVicar,1 M. Martin,1 C. Ho,1 B. Maas,1 J. Hay,1 J. Wu,1 M. Keyes,2 and E. Berthelet1; 1BC Cancer Agency, Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada Purpose/Objective(s): Curative radiation therapy (RT) for locally advanced nasopharyngeal carcinoma (NPC) is based on the gross tumor volume (GTV), but the magnitude and timing of GTV changes during combined modality therapy remain unclear. This study analyzes GTV changes at phases of induction chemotherapy and sequential concurrent chemoradiation therapy (CRT) in patients with locally advanced NPC. Materials/Methods: Subjects included 13 patients with newly diagnosed stage III-IV NPC who underwent treatment between 2011 and 2014. Criteria for eligibility included 2 cycles of neoadjuvant chemotherapy, at least 5 cycles of concurrent chemotherapy and 3 magnetic resonance imaging (MRI) scans at specific phases of treatment (T0: before treatment, T1: postinduction, and T3: 3 months after CRT). The induction phase consisted of 2 cycles of gemcitabine and cisplatin. The CRT phase consisted of weekly cisplatin and RT delivered using volumetric modulated arc therapy (VMAT). The total dose was 70 Gy over 35 daily fractions administered 5 days/week. A subset of 3 patients received an additional MRI 4 to 5 weeks into CRT (T2). Primary gross tumor volume (GTVp) was defined as the GTV and adjacent involved retropharyngeal lymph nodes. Tumor volumes were delineated on gadolinium-enhanced fatsaturation T1 weighted MRIs by 2 observers. Mean values are reported +/one standard deviation. Results: Preliminary analysis included 6 (out of 13) subjects. The mean initial GTVp was 62.7 +/- 32.8 mL. The mean GTVp response after induction phase was 21.4% +/- 12.3% with a mean rate of volume change of 0.31 +/- 0.19 mL/day which corresponded to a 0.56% +/- 0.35% daily reduction in tumor volume. The total mean GTVp response after completion of treatment (T3) was 77.6% 21.6%. Subgroup analysis of subjects who underwent an additional MRI showed a mean GTVp reduction of 42.5% 22.6% and a mean rate of volume change of 0.87 0.08 mL/day which corresponded to a 1.7% 0.93% daily reduction in tumor volume (from T1 to T2). Conclusion: Preliminary results suggest that the GTVp progressively diminishes following both induction chemotherapy and CRT. The mean GTVp response after 4 to 5 weeks of CRT exceeded the response observed after induction chemotherapy by a factor of 2. The mean rate of volume change at 4 to 5 weeks of CRT was threefold the rate seen during induction chemotherapy. These observations may support the optimal timing of imaging for replanning in the context of adaptive field RT. Analysis of the full NPC patient dataset is ongoing and will be reported. Author Disclosure: J.A. Giambattista: None. N. McVicar: None. M. Martin: None. C. Ho: None. B. Maas: None. J. Hay: None. J. Wu: None. M. Keyes: None. E. Berthelet: None.
185 C-Reactive Protein as a Biomarker of Radiation Therapy and Chemotherapy Toxicity Monitoring in Patients With Head and Neck Cancer A. Wygoda, J.J. Mrochem-Kwarciak, M. Kentnowski, T. Rutkowski, B. Pilecki, A. Heyda, A. Hajduk, U. Dworzecka, I.J. Gawron, K. Grabinska, L.P. Michalecki, P. Polanowski, and K.A. Skladowski; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland Purpose/Objective(s): C-reactive protein (CRP) is a serum protein elevated in a variety of illnesses, including cancer. Also some data exist that CRP level is correlated with acute mucositis in patients (pts) with head and neck cancer (HNC) treated with radiation therapy (RT) and
Posters
905
significantly elevated when dose/fraction number is increased. The purpose of this study is to show how CRP behaves before and after HNC RT with or without chemotherapy. Materials/Methods: From 2010 to 2015, 401 pts (318 men and 83 women) with a mean age of 58 years (range 20-81) with oral cavity (5), nasopharynx (30), oropharynx (133), hypopharynx (47), larynx (180), or unknown primary (6) cancer were under treatment. Tumor stage was evaluated in all pts: T0-6, T1-60, T2-147, T3-119, T4-69, and N0-174, N152, N2-143, and N3-32. Four schedules of treatment have been used: RT alone (RTA, 178 pts), concurrent chemoradiation therapy (CRC, 93 pts), and induction chemotherapy (IC) followed by RTA (46 pts) or CRC (84 pts). CRP (normal level, <2.87mg/L) was measured as follows: before IC (if applied) or before RTA/CRC, every week during RTA/CRC, and, finally, 1 month after treatment. Total number of CRP measurements was 3622. Results: Initial CRP level was normal in 56% of pts; in 44% it was elevated (median 6.05 mg/L) but not correlated with tumor advancement. After IC, normalization of CRP was observed in 73% of pts (median CRP decreased from 3.12 to 1.24 mg/L). During RT progressive, week by week up to week 6, elevation of CRP was observed for RTA and CRC with no difference between both treatments. However, evident impacts of initial CRP level and IC were noted; in patients who had abnormal initial CRP and/or IC, significantly higher CRP levels were observed over RTA and CRC. There was no correlation observed between CRP and total dose or overall volume of radiated tissue. Conclusion: CRP may be a useful laboratory parameter in monitoring of toxicity in HNC patients undergoing RTA and CRC. IC leads to significant reduction/normalization of CRP in the majority of patients, which may reflect an anti-inflammatory effect in tumor burden. Similar CRP levels in patients treated with RTA and CRC may suggest that tumor and normal tissue radiation sensitivity is an essential proinflammatory factor. Author Disclosure: A. Wygoda: None. J.J. Mrochem-Kwarciak: None. M. Kentnowski: None. T. Rutkowski: None. B. Pilecki: None. A. Heyda: None. A. Hajduk: None. U. Dworzecka: None. I. Gawron: None. K. Grabinska: None. L.P. Michalecki: None. P. Polanowski: None. K.A. Skladowski: None.
186 Adaptive Radiation Therapy in Adults With Nasopharyngeal Carcinoma: A Retrospective Study at 1 Institution N. Alsafadi,1 M. Khan,2 M. Abrar,2 F. Saeedi,2 Y. Albarakati,2 A. Alshaikh,2 M. Algarni,2 B. AL Ahmad,2 C. Chantel,2 S. Jaber,2 and E. Noor2; 1Radiation Oncology. King Abdulaziz Medical City PNOC, Jeddah, Saudi Arabia, 2PNOC-KAMC, JEDDAH, Saudi Arabia Purpose/Objective(s): To determine whether nasopharyngeal carcinoma (NPC) patients benefit from adaptive radiation therapy (ART) in terms of tumor coverage and/or organ at risk (OAR) sparing. We also aim at determining patients with higher risk for plan deterioration according to potential predictive factors. Materials/Methods: According to our institution protocol, all NPC patients treated radically with or without concurrent chemotherapy receive adaptive radiation therapy (ART). We reviewed the planning parameters of 40 such patients treated from January 2013 to December 2014. Since our protocol calls for induction chemotherapy in locally advanced disease, none of our patients had bulky neck nodes (more than 6 cm) at the start of radiation therapy. All patients were treated using volumetric modulated arc therapy (VMAT) with simultaneous integrated boost with 2 dose levels, 70 Gy and 60 Gy, all in 35 fractions. Patients were replanned systematically twice during radiation therapy on days 15 and 29. The resulting ART plans were compared to the non-ART (NART) plans generated retrospectively for the purpose of this study only. This review focuses on target coverage and OARs doses. Three potential predictive factors for plan deterioration were analyzed. These include the maximum positional shift (MPS) on day 15, neck separation reduction (NSR) on day 15, and percentage weight loss (PWL) on day 21.
906
International Journal of Radiation Oncology Biology Physics
Results: For the entire series, ART plans had significantly better planning target volume (PTV) coverage. The mean percentage dose covering 95% of PTV (D95) was 96.44% for ART versus 95.58% for NART (PZ.0003) for PTV70, and 94.63% for ART versus 93.94% for NART (PZ.0009) for PTV60. Using our treatment setup, only MPS was able to define 2 risk groups for plan deterioration. The high-risk group (HRG) comprises 27 patients with MPS>1 mm and the low-risk group (LRG) comprises 13 patients with MPS1 mm. The mean PTV70 (D95) for ART versus N-ART for the HRG and LRG were 96.44% versus 95.36% (PZ.0001), and 96.15% versus 96.02% (PZ.686). The same was true for PTV60 with 94.93% versus 93.36% (PZ.0033), and 94.62% versus 94.00% (PZ.104). When compared to ART, 6 out of 40 NART plans had a PTV70 and/or PTV60 (D95) drop exceeding 3% (PZ.0255), 5 of them in the HRG. The ART plans achieved a significantly lower spinal cord dose maximum (SCMD) of 42.64 Gy versus 44.47 Gy (PZ.0001). Only 1 patient in this group had SCMD exceeding 46 Gy as compared to 13 in NART plans (PZ.0012). The improvement in the mean parotid dose with ART in this series did not reach statistical significance (33.35 Gy versus 34.20 Gy, PZ.063). Conclusion: ART plans resulted in improved tumor coverage and better spinal cord sparing compared to the corresponding NART plans in the present NPC patient series. Further evaluation of the value of the predictive factors will be carried out in a larger sample of patients. Author Disclosure: N. Alsafadi: None. M. Khan: None. M. Abrar: None. F. Saeedi: None. Y. Albarakati: None. A. Alshaikh: None. M. Algarni: None. B. AL Ahmad: None. C. Chantel: None. S. Jaber: None. E. Noor: None.
Amongst those from 2007 to 2015, 9 or 11 were in patients with locally advanced disease. Three studies demonstrated the survival benefit of induction chemotherapy, 2 studies demonstrated the benefit of TPF versus PF, and 3 studies demonstrated the survival benefit of novel monoclonal antibodies (ie, nimotuzumab). Conclusion: Since 1996, the number of clinical trials of HNSCC presented at the ASCO annual meeting has increased. There has been a marked increase in the exploration of either novel drugs or novel drug combinations. This has not translated into statistically significant improvements in overall survival because most trials were nonrandomized, phase 2 studies. More randomized clinical trials are needed to build on the successes seen in the treatment of HNSCC. Novel drugs and/or drug combinations will likely lead to paradigm shifts in the treatment of human papillomavirusepositive HNSCC. Author Disclosure: J. Moreira: None. M. Agulnik: None. A. Rademaker: None.
187 Trends in Head and Neck Squamous Cell Carcinoma (HNSCC) Clinical Research as Reported in the American Society of Clinical Oncology (ASCO) Proceedings From 1996 to 2015 J. Moreira,1 M. Agulnik,1 and A. Rademaker2; 1Northwestern University Feinberg School of Medicine, Division of Hematology/Oncology, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Division of Preventive Medicine-Biostatistics, Chicago, IL Purpose/Objective(s): The direction of clinical research can be ascertained by reviewing ASCO Proceedings abstracts. We aimed to identify trends in HNSCC as reported in the ASCO annual meetings from 1996 to 2015 to determine whether clinical research findings lead to an improvement in patient survival. Materials/Methods: All abstracts in the head and neck section of the ASCO Proceedings from 1996 to 2015 were reviewed. Abstracts on locally advanced, recurrent, or metastatic HNSCC were further explored. Descriptive summary information was recorded regarding number of authors, randomization, trial phase, presence of novel drug or combination therapies, timing of chemotherapy, and disease-free and overall survival. Results: From 1996 to 2015, there were a total of 2294 head and neck cancer abstracts. From 1996 to 2006, 207 abstracts were presented at the ASCO annual meeting. From 2007 to 2015, 158 abstracts were presented, of which 59 were presented at oral abstract or poster discussion sessions. The average number of authors from 1996 to 2007 was 8.82, and 10.77 from 2007 to 2015, with an average number of authors from 1996 to 2015 of 9.66. Sixty percent of studies from 1996 to 2006 focused on locally advanced disease, compared to 62% from 2007 to 2015. From 1996 to 2006, 27% were randomized studies versus 41% from 2007 to 2015. From 1996 to 2006, 57% of abstracts explored concurrent chemoradiation therapy, versus 55% of abstracts from 2006 to 2015. Fifty percent of abstracts from 1996 to 2006 investigated a novel drug or novel drug combination, compared to 95% of abstracts from 2007 to 2015. Six percent of abstracts from 1996 to 2006 demonstrated a statistically significant improvement in survival compared to 7% of abstracts from 2007 to 2015. Amongst those abstracts from 1996 to 2006, all were of patients with locally advanced disease, with the majority (7 of 12) showing a survival benefit of radiation administered with chemotherapy or cetuximab.
188 The Effect of Body Mass Index on Outcomes of Cervical Lymphadenectomy P. DeVries, C. Nocon, A. Wieland, G.K. Hartig, and T.M. McCulloch; University of Wisconsin, Madison, WI Purpose/Objective(s): To determine which factors, including body mass index (BMI), affect the outcomes of neck dissections as they relate to lymph node yield and postoperative complications. Materials/Methods: A retrospective chart review was performed on 354 subjects who had undergone a neck dissection between 1992 and 2010 at an academic medical center. BMI, type of neck dissection, lymph node yield, demographic information, comorbidities, cancer histology, and history of radiation were identified. Univariate analyses of variances and independent t tests were performed to determine the effects of BMI on the lymph node yield and postoperative complications of neck dissections. Results: There was an association between increased BMI and increased lymph node yields after controlling for history of radiation (PZ.001). Patients who were categorized as obese (BMI30) had a significantly higher lymph node yield compared to those with a BMI less than 30 (PZ.005). Obese and nonobese patients averaged 8.44 and 6.95 nodes per neck level dissected, respectively. There were no associations between postoperative complications and an increased BMI. The average number of lymph nodes per neck level dissected for patients with N1, N2a, N2b, N2c, and N3 staged cancer were 8.52, 7.81, 7.21, 6.56, and 5.34, respectively. Conclusion: These results show an increase in lymph node yield in patients with elevated BMI, no history of radiation, and an earlier N-staged cancer. There is no consensus on what constitutes an adequate lymph node yield in neck dissections. This study demonstrates that patient- and disease-specific features may impact the lymph node yield. Author Disclosure: P. DeVries: None. C. Nocon: None. A. Wieland: None. G.K. Hartig: None. T.M. McCulloch: None.
189 Nodal Volume as a Prognostic Factor in Locally Advanced Head and Neck Cancer Treated With Concurrent Chemoradiaton With IGRT: An Updated Analysis From an Indian Institution B. Dua,1 K.S. Chufal,2 and G. Jadhav1; 1APOLLO HOSPITAL, New delhi, India, 2Batra Hospital and Medical Research Centre, delhi, India Purpose/Objective(s): Nodal volume as a prognostic factor has been extensively evaluated in head and neck cancer; however, there is still no consensus. While the older studies have used 3-dimensional techniques, outdated volume calculation methods are retrospective, and not all patients have consistently received chemotherapy, the newer studies done with intensity modulated radiation therapy (IMRT) have mostly subjected patients to an elective neck dissection following chemoradiation (CRT), confounding the association between nodal volume and prognosis. We attempted to analyze nodal volume as a prognostic factor in head and neck
184 Magnitude and Timing of Gross Tumor Volume Response to Neoadjuvant Chemotherapy and Concurrent Chemoradiation in the Treatment of Locally Advanced Nasopharyngeal Carcinoma J.A. Giambattista,1 N. McVicar,1 M. Martin,1 C. Ho,1 B. Maas,1 J. Hay,1 J. Wu,1 M. Keyes,2 and E. Berthelet1; 1BC Cancer Agency, Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada Purpose/Objective(s): Curative radiation therapy (RT) for locally advanced nasopharyngeal carcinoma (NPC) is based on the gross tumor volume (GTV), but the magnitude and timing of GTV changes during combined modality therapy remain unclear. This study analyzes GTV changes at phases of induction chemotherapy and sequential concurrent chemoradiation therapy (CRT) in patients with locally advanced NPC. Materials/Methods: Subjects included 13 patients with newly diagnosed stage III-IV NPC who underwent treatment between 2011 and 2014. Criteria for eligibility included 2 cycles of neoadjuvant chemotherapy, at least 5 cycles of concurrent chemotherapy and 3 magnetic resonance imaging (MRI) scans at specific phases of treatment (T0: before treatment, T1: postinduction, and T3: 3 months after CRT). The induction phase consisted of 2 cycles of gemcitabine and cisplatin. The CRT phase consisted of weekly cisplatin and RT delivered using volumetric modulated arc therapy (VMAT). The total dose was 70 Gy over 35 daily fractions administered 5 days/week. A subset of 3 patients received an additional MRI 4 to 5 weeks into CRT (T2). Primary gross tumor volume (GTVp) was defined as the GTV and adjacent involved retropharyngeal lymph nodes. Tumor volumes were delineated on gadolinium-enhanced fatsaturation T1 weighted MRIs by 2 observers. Mean values are reported +/one standard deviation. Results: Preliminary analysis included 6 (out of 13) subjects. The mean initial GTVp was 62.7 +/- 32.8 mL. The mean GTVp response after induction phase was 21.4% +/- 12.3% with a mean rate of volume change of 0.31 +/- 0.19 mL/day which corresponded to a 0.56% +/- 0.35% daily reduction in tumor volume. The total mean GTVp response after completion of treatment (T3) was 77.6% 21.6%. Subgroup analysis of subjects who underwent an additional MRI showed a mean GTVp reduction of 42.5% 22.6% and a mean rate of volume change of 0.87 0.08 mL/day which corresponded to a 1.7% 0.93% daily reduction in tumor volume (from T1 to T2). Conclusion: Preliminary results suggest that the GTVp progressively diminishes following both induction chemotherapy and CRT. The mean GTVp response after 4 to 5 weeks of CRT exceeded the response observed after induction chemotherapy by a factor of 2. The mean rate of volume change at 4 to 5 weeks of CRT was threefold the rate seen during induction chemotherapy. These observations may support the optimal timing of imaging for replanning in the context of adaptive field RT. Analysis of the full NPC patient dataset is ongoing and will be reported. Author Disclosure: J.A. Giambattista: None. N. McVicar: None. M. Martin: None. C. Ho: None. B. Maas: None. J. Hay: None. J. Wu: None. M. Keyes: None. E. Berthelet: None.
185 C-Reactive Protein as a Biomarker of Radiation Therapy and Chemotherapy Toxicity Monitoring in Patients With Head and Neck Cancer A. Wygoda, J.J. Mrochem-Kwarciak, M. Kentnowski, T. Rutkowski, B. Pilecki, A. Heyda, A. Hajduk, U. Dworzecka, I.J. Gawron, K. Grabinska, L.P. Michalecki, P. Polanowski, and K.A. Skladowski; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland Purpose/Objective(s): C-reactive protein (CRP) is a serum protein elevated in a variety of illnesses, including cancer. Also some data exist that CRP level is correlated with acute mucositis in patients (pts) with head and neck cancer (HNC) treated with radiation therapy (RT) and
Posters
905
significantly elevated when dose/fraction number is increased. The purpose of this study is to show how CRP behaves before and after HNC RT with or without chemotherapy. Materials/Methods: From 2010 to 2015, 401 pts (318 men and 83 women) with a mean age of 58 years (range 20-81) with oral cavity (5), nasopharynx (30), oropharynx (133), hypopharynx (47), larynx (180), or unknown primary (6) cancer were under treatment. Tumor stage was evaluated in all pts: T0-6, T1-60, T2-147, T3-119, T4-69, and N0-174, N152, N2-143, and N3-32. Four schedules of treatment have been used: RT alone (RTA, 178 pts), concurrent chemoradiation therapy (CRC, 93 pts), and induction chemotherapy (IC) followed by RTA (46 pts) or CRC (84 pts). CRP (normal level, <2.87mg/L) was measured as follows: before IC (if applied) or before RTA/CRC, every week during RTA/CRC, and, finally, 1 month after treatment. Total number of CRP measurements was 3622. Results: Initial CRP level was normal in 56% of pts; in 44% it was elevated (median 6.05 mg/L) but not correlated with tumor advancement. After IC, normalization of CRP was observed in 73% of pts (median CRP decreased from 3.12 to 1.24 mg/L). During RT progressive, week by week up to week 6, elevation of CRP was observed for RTA and CRC with no difference between both treatments. However, evident impacts of initial CRP level and IC were noted; in patients who had abnormal initial CRP and/or IC, significantly higher CRP levels were observed over RTA and CRC. There was no correlation observed between CRP and total dose or overall volume of radiated tissue. Conclusion: CRP may be a useful laboratory parameter in monitoring of toxicity in HNC patients undergoing RTA and CRC. IC leads to significant reduction/normalization of CRP in the majority of patients, which may reflect an anti-inflammatory effect in tumor burden. Similar CRP levels in patients treated with RTA and CRC may suggest that tumor and normal tissue radiation sensitivity is an essential proinflammatory factor. Author Disclosure: A. Wygoda: None. J.J. Mrochem-Kwarciak: None. M. Kentnowski: None. T. Rutkowski: None. B. Pilecki: None. A. Heyda: None. A. Hajduk: None. U. Dworzecka: None. I. Gawron: None. K. Grabinska: None. L.P. Michalecki: None. P. Polanowski: None. K.A. Skladowski: None.
186 Adaptive Radiation Therapy in Adults With Nasopharyngeal Carcinoma: A Retrospective Study at 1 Institution N. Alsafadi,1 M. Khan,2 M. Abrar,2 F. Saeedi,2 Y. Albarakati,2 A. Alshaikh,2 M. Algarni,2 B. AL Ahmad,2 C. Chantel,2 S. Jaber,2 and E. Noor2; 1Radiation Oncology. King Abdulaziz Medical City PNOC, Jeddah, Saudi Arabia, 2PNOC-KAMC, JEDDAH, Saudi Arabia Purpose/Objective(s): To determine whether nasopharyngeal carcinoma (NPC) patients benefit from adaptive radiation therapy (ART) in terms of tumor coverage and/or organ at risk (OAR) sparing. We also aim at determining patients with higher risk for plan deterioration according to potential predictive factors. Materials/Methods: According to our institution protocol, all NPC patients treated radically with or without concurrent chemotherapy receive adaptive radiation therapy (ART). We reviewed the planning parameters of 40 such patients treated from January 2013 to December 2014. Since our protocol calls for induction chemotherapy in locally advanced disease, none of our patients had bulky neck nodes (more than 6 cm) at the start of radiation therapy. All patients were treated using volumetric modulated arc therapy (VMAT) with simultaneous integrated boost with 2 dose levels, 70 Gy and 60 Gy, all in 35 fractions. Patients were replanned systematically twice during radiation therapy on days 15 and 29. The resulting ART plans were compared to the non-ART (NART) plans generated retrospectively for the purpose of this study only. This review focuses on target coverage and OARs doses. Three potential predictive factors for plan deterioration were analyzed. These include the maximum positional shift (MPS) on day 15, neck separation reduction (NSR) on day 15, and percentage weight loss (PWL) on day 21.
906
International Journal of Radiation Oncology Biology Physics
Results: For the entire series, ART plans had significantly better planning target volume (PTV) coverage. The mean percentage dose covering 95% of PTV (D95) was 96.44% for ART versus 95.58% for NART (PZ.0003) for PTV70, and 94.63% for ART versus 93.94% for NART (PZ.0009) for PTV60. Using our treatment setup, only MPS was able to define 2 risk groups for plan deterioration. The high-risk group (HRG) comprises 27 patients with MPS>1 mm and the low-risk group (LRG) comprises 13 patients with MPS1 mm. The mean PTV70 (D95) for ART versus N-ART for the HRG and LRG were 96.44% versus 95.36% (PZ.0001), and 96.15% versus 96.02% (PZ.686). The same was true for PTV60 with 94.93% versus 93.36% (PZ.0033), and 94.62% versus 94.00% (PZ.104). When compared to ART, 6 out of 40 NART plans had a PTV70 and/or PTV60 (D95) drop exceeding 3% (PZ.0255), 5 of them in the HRG. The ART plans achieved a significantly lower spinal cord dose maximum (SCMD) of 42.64 Gy versus 44.47 Gy (PZ.0001). Only 1 patient in this group had SCMD exceeding 46 Gy as compared to 13 in NART plans (PZ.0012). The improvement in the mean parotid dose with ART in this series did not reach statistical significance (33.35 Gy versus 34.20 Gy, PZ.063). Conclusion: ART plans resulted in improved tumor coverage and better spinal cord sparing compared to the corresponding NART plans in the present NPC patient series. Further evaluation of the value of the predictive factors will be carried out in a larger sample of patients. Author Disclosure: N. Alsafadi: None. M. Khan: None. M. Abrar: None. F. Saeedi: None. Y. Albarakati: None. A. Alshaikh: None. M. Algarni: None. B. AL Ahmad: None. C. Chantel: None. S. Jaber: None. E. Noor: None.
Amongst those from 2007 to 2015, 9 or 11 were in patients with locally advanced disease. Three studies demonstrated the survival benefit of induction chemotherapy, 2 studies demonstrated the benefit of TPF versus PF, and 3 studies demonstrated the survival benefit of novel monoclonal antibodies (ie, nimotuzumab). Conclusion: Since 1996, the number of clinical trials of HNSCC presented at the ASCO annual meeting has increased. There has been a marked increase in the exploration of either novel drugs or novel drug combinations. This has not translated into statistically significant improvements in overall survival because most trials were nonrandomized, phase 2 studies. More randomized clinical trials are needed to build on the successes seen in the treatment of HNSCC. Novel drugs and/or drug combinations will likely lead to paradigm shifts in the treatment of human papillomavirusepositive HNSCC. Author Disclosure: J. Moreira: None. M. Agulnik: None. A. Rademaker: None.
187 Trends in Head and Neck Squamous Cell Carcinoma (HNSCC) Clinical Research as Reported in the American Society of Clinical Oncology (ASCO) Proceedings From 1996 to 2015 J. Moreira,1 M. Agulnik,1 and A. Rademaker2; 1Northwestern University Feinberg School of Medicine, Division of Hematology/Oncology, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Division of Preventive Medicine-Biostatistics, Chicago, IL Purpose/Objective(s): The direction of clinical research can be ascertained by reviewing ASCO Proceedings abstracts. We aimed to identify trends in HNSCC as reported in the ASCO annual meetings from 1996 to 2015 to determine whether clinical research findings lead to an improvement in patient survival. Materials/Methods: All abstracts in the head and neck section of the ASCO Proceedings from 1996 to 2015 were reviewed. Abstracts on locally advanced, recurrent, or metastatic HNSCC were further explored. Descriptive summary information was recorded regarding number of authors, randomization, trial phase, presence of novel drug or combination therapies, timing of chemotherapy, and disease-free and overall survival. Results: From 1996 to 2015, there were a total of 2294 head and neck cancer abstracts. From 1996 to 2006, 207 abstracts were presented at the ASCO annual meeting. From 2007 to 2015, 158 abstracts were presented, of which 59 were presented at oral abstract or poster discussion sessions. The average number of authors from 1996 to 2007 was 8.82, and 10.77 from 2007 to 2015, with an average number of authors from 1996 to 2015 of 9.66. Sixty percent of studies from 1996 to 2006 focused on locally advanced disease, compared to 62% from 2007 to 2015. From 1996 to 2006, 27% were randomized studies versus 41% from 2007 to 2015. From 1996 to 2006, 57% of abstracts explored concurrent chemoradiation therapy, versus 55% of abstracts from 2006 to 2015. Fifty percent of abstracts from 1996 to 2006 investigated a novel drug or novel drug combination, compared to 95% of abstracts from 2007 to 2015. Six percent of abstracts from 1996 to 2006 demonstrated a statistically significant improvement in survival compared to 7% of abstracts from 2007 to 2015. Amongst those abstracts from 1996 to 2006, all were of patients with locally advanced disease, with the majority (7 of 12) showing a survival benefit of radiation administered with chemotherapy or cetuximab.
188 The Effect of Body Mass Index on Outcomes of Cervical Lymphadenectomy P. DeVries, C. Nocon, A. Wieland, G.K. Hartig, and T.M. McCulloch; University of Wisconsin, Madison, WI Purpose/Objective(s): To determine which factors, including body mass index (BMI), affect the outcomes of neck dissections as they relate to lymph node yield and postoperative complications. Materials/Methods: A retrospective chart review was performed on 354 subjects who had undergone a neck dissection between 1992 and 2010 at an academic medical center. BMI, type of neck dissection, lymph node yield, demographic information, comorbidities, cancer histology, and history of radiation were identified. Univariate analyses of variances and independent t tests were performed to determine the effects of BMI on the lymph node yield and postoperative complications of neck dissections. Results: There was an association between increased BMI and increased lymph node yields after controlling for history of radiation (PZ.001). Patients who were categorized as obese (BMI30) had a significantly higher lymph node yield compared to those with a BMI less than 30 (PZ.005). Obese and nonobese patients averaged 8.44 and 6.95 nodes per neck level dissected, respectively. There were no associations between postoperative complications and an increased BMI. The average number of lymph nodes per neck level dissected for patients with N1, N2a, N2b, N2c, and N3 staged cancer were 8.52, 7.81, 7.21, 6.56, and 5.34, respectively. Conclusion: These results show an increase in lymph node yield in patients with elevated BMI, no history of radiation, and an earlier N-staged cancer. There is no consensus on what constitutes an adequate lymph node yield in neck dissections. This study demonstrates that patient- and disease-specific features may impact the lymph node yield. Author Disclosure: P. DeVries: None. C. Nocon: None. A. Wieland: None. G.K. Hartig: None. T.M. McCulloch: None.
189 Nodal Volume as a Prognostic Factor in Locally Advanced Head and Neck Cancer Treated With Concurrent Chemoradiaton With IGRT: An Updated Analysis From an Indian Institution B. Dua,1 K.S. Chufal,2 and G. Jadhav1; 1APOLLO HOSPITAL, New delhi, India, 2Batra Hospital and Medical Research Centre, delhi, India Purpose/Objective(s): Nodal volume as a prognostic factor has been extensively evaluated in head and neck cancer; however, there is still no consensus. While the older studies have used 3-dimensional techniques, outdated volume calculation methods are retrospective, and not all patients have consistently received chemotherapy, the newer studies done with intensity modulated radiation therapy (IMRT) have mostly subjected patients to an elective neck dissection following chemoradiation (CRT), confounding the association between nodal volume and prognosis. We attempted to analyze nodal volume as a prognostic factor in head and neck