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Chemoradiotherapy for HPV-related Oropharyngeal SCC
I. J. Radiation Oncology d Biology d Physics
S502
Volume 81, Number 2, Supplement, 2011
patient-reported data, EMR was reviewed to abstract smoking/alcohol data. Patient notes were freely dictated by physicians without a set template. Cohen’s kappa statistic and Pearson correlation coefficient were used to analyze agreement between QU and EMR records. Results: 909 HNC patients were reviewed: 78% male; 88% white; median age 61yrs (range 28 - 91yrs); subtypes: oropharynx 41%, oral cavity 18%; larynx 26%; hypopharynx 5%; others 10%. Stage I 8%, II 13%, III 16%, IV 63%. According to QU data, 637 (70%) were ever (current + ex) smokers, 252 (28%) never-smokers, and 20 (2%) missing data. From the QU, the median PY for smokers was 30 (0.1 - 150) PY. When comparing EMR to QU data, 821 (96%) of individuals matched on smoking status (evervs. never-); kappa = 0.90 (95% CI 0.87 - 0.93). Comparing PY, the Pearson coefficient (R2) was 0.67. 82 (12%) of ever-smokers had .20 PY difference, while 165 (24%) of ever-smokers had .10 PY difference. For alcohol intake QU data, 461 (54%) were current drinkers; 194 (23%) ex-drinker; 167 (20%) never drinker; 30 (4%) missing data. When comparing EMR to QU data, everand never-drinker status had 88% agreement, kappa = 0.62 (95% CI 0.55 - 0.69). Data for alcohol drink-years, type of alcohol intake, marijuana use, or pipe-smoking was not evaluable in almost all HNC patients through EMR, but was available for QU patients, when such a question appeared on the survey. Conclusions: The agreement between QU and EMR appears to be consistent for smoking status, but more discordant for alcohol status. Our analysis highlights the potential limitations of retrospective medical records for assessing social habits in outcomes analysis. Further studies determining predictors of mismatching data are currently underway. Author Disclosure: S. Habbous: None. K.P. Chu: None. H. Shao Hui: None. W. Xu: None. L. Cheng: None. A. Tse: None. D.P. Goldstein: None. J. Waldron: None. B. O’Sullivan: None. G. Liu: None.
2610
Chemoradiotherapy for HPV-related Oropharyngeal SCC
G. Sanguineti, S. Marur, C. Gourin, W. Koch, W. Westra, N. Aygun, N. Agrawal, H. Starmer, A. Forastiere Johns Hopkins University, Baltimore, MD Purpose/Objective(s): To describe the outcome of a consecutive and contemporary series of patients with HPV-related, bxproven oropharyngeal SCC at a single Institution. Materials/Methods: All patients treated with definitive combined chemoradiotherapy for T1 - 2N2 - 3/T3 - 4N0 - 3 HPV-related oropharyngeal SCC from August 2007 to December 2009 were considered for analysis. p16 (IHC) and HPV (ISH) testing were routinely performed using a broad spectrum probe. Concomitant chemoradiotherapy consisted of dose-painting IMRT to 3 dose levels (70, 63, 58.1 Gy in 35 fxs over 7 weeks) and single-agent platinum chemotherapy; induction chemotherapy with TPF was considered for patients with T4 and/or N3 disease if medically fit. All patients were offered speech and swallowing evaluation and management as well as prophylactic PEG tube placement with encouragement to maintain oral intake. Actuarial curves were computed using the KM method and compared with log-rank test. Results: 65 patients were analyzed. Pt characteristics: 55 males (86.2%) and 10 females (13.8%); median age -56 yrs (30 - 75); smoking history: 31 (47.7%) never smoked; 22 (33.8%) former smokers, and 12 (18.5%) current smokers. All tumor specimens were p16 positive and 58/65 (89.2%) were HPV positive. Primary site was base of tongue -35 pts (53.8%); tonsil -28 pts (43.1%); pharyngeal wall -1 pt (1.5%) and soft palate -1 pt (1.5%). Most patients had early T stage disease (T1, 20 pts, 30.8%; T2, 27 pts, 41.5%; T3, 7 pts, 10.8%; T4, 11 pts, 16.9%). 56 patients (86.1%) had clinically involved neck nodes at presentation; of these, 5 underwent upfront neck dissection and all had ECE. Eight patients (12.3%) received induction chemotherapy. At a median follow up of 22.1 months (10.4 - 42.1 mths), 4 patients developed local and/or regional failure for an estimated 2-yr locoregional control (LRC) rate of 90.1 + 4.9%. Predictors of better LRC by univariate analysis were early T stage (T1 - 2, p = 0.013) and male sex (p\0.001). Surgical salvage was attempted in all LR failures for an ultimate LRC rate of 96.0 + 2.8% at 2 yrs. Four patients developed distant metastasis; 2-yr overall survival is 94.9 + 3.7%. PEG tube dependency rates were 10.5 + 3.9% and 5.3 + 4.2% at 1 and 2 yrs, respectively. Patients with early T stage (T1 - 2, p = 0.001) and with no symptoms at presentation (painless neck mass, p\0.001) had significantly shorter duration PEG tube dependency (maximum 9 months). Regarding xerostomia, the actuarial rate of bottle of water dependency at 2 yrs is 25.5 ± 6.7%. Conclusions: Chemoradiotherapy is a highly effective treatment option for HPV-related oropharyngeal SCC with minimal long term morbidity; patients with T3 - 4 disease are at higher risk of failure and less likely to regain functional swallowing capabilities. These data also suggest possible gender differences in tumor responsiveness to chemoradiation. Author Disclosure: G. Sanguineti: None. S. Marur: None. C. Gourin: None. W. Koch: None. W. Westra: None. N. Aygun: None. N. Agrawal: None. H. Starmer: None. A. Forastiere: None.
2611
Low-dose Fractionated Radiation (LDFRT) as a Chemopotentiator of Neoadjuvant Paclitaxel and Carboplatin for Locally Advanced Squamous Cell Carcinoma of the Head and Neck: 5 Year Results Of A Prospective Phase II Trial
J. F. Gleason1, M. Kudrimoti1, E. M. Van Meter1, M. Mohiuddin2, W. F. Regine3, J. Valentino1, S. M. Arnold1 1 3
University of Kentucky, Lexington, KY, 2King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, University of Maryland, Baltimore, MD
Purpose/Objective(s): LDFRT (\ 100 cGy) induces enhanced cell killing in-vitro via hyper-radiation sensitivity phenomenon, but has not been utilized clinically. A novel treatment approach was designed utilizing neoadjuvant LDFRT and chemotherapy (CMT) for locally advanced SCCHN. Materials/Methods: 40 patients with locally advanced SCCHN were prospectively enrolled on a phase II clinical trial and treated with induction paclitaxel (225mg/m2), carboplatin (AUC 6), and four 80 cGy fractions of radiation (XRT) (BID on Day 1 and 2). This sequence was repeated on Days 22 and 23. Patients were evaluated for response by clinical exam, endoscopy, and imaging. A multidisciplinary team then made decisions about definitive treatment following induction. Definitive therapy was determined based on response to induction.
S502
Volume 81, Number 2, Supplement, 2011
patient-reported data, EMR was reviewed to abstract smoking/alcohol data. Patient notes were freely dictated by physicians without a set template. Cohen’s kappa statistic and Pearson correlation coefficient were used to analyze agreement between QU and EMR records. Results: 909 HNC patients were reviewed: 78% male; 88% white; median age 61yrs (range 28 - 91yrs); subtypes: oropharynx 41%, oral cavity 18%; larynx 26%; hypopharynx 5%; others 10%. Stage I 8%, II 13%, III 16%, IV 63%. According to QU data, 637 (70%) were ever (current + ex) smokers, 252 (28%) never-smokers, and 20 (2%) missing data. From the QU, the median PY for smokers was 30 (0.1 - 150) PY. When comparing EMR to QU data, 821 (96%) of individuals matched on smoking status (evervs. never-); kappa = 0.90 (95% CI 0.87 - 0.93). Comparing PY, the Pearson coefficient (R2) was 0.67. 82 (12%) of ever-smokers had .20 PY difference, while 165 (24%) of ever-smokers had .10 PY difference. For alcohol intake QU data, 461 (54%) were current drinkers; 194 (23%) ex-drinker; 167 (20%) never drinker; 30 (4%) missing data. When comparing EMR to QU data, everand never-drinker status had 88% agreement, kappa = 0.62 (95% CI 0.55 - 0.69). Data for alcohol drink-years, type of alcohol intake, marijuana use, or pipe-smoking was not evaluable in almost all HNC patients through EMR, but was available for QU patients, when such a question appeared on the survey. Conclusions: The agreement between QU and EMR appears to be consistent for smoking status, but more discordant for alcohol status. Our analysis highlights the potential limitations of retrospective medical records for assessing social habits in outcomes analysis. Further studies determining predictors of mismatching data are currently underway. Author Disclosure: S. Habbous: None. K.P. Chu: None. H. Shao Hui: None. W. Xu: None. L. Cheng: None. A. Tse: None. D.P. Goldstein: None. J. Waldron: None. B. O’Sullivan: None. G. Liu: None.
2610
Chemoradiotherapy for HPV-related Oropharyngeal SCC
G. Sanguineti, S. Marur, C. Gourin, W. Koch, W. Westra, N. Aygun, N. Agrawal, H. Starmer, A. Forastiere Johns Hopkins University, Baltimore, MD Purpose/Objective(s): To describe the outcome of a consecutive and contemporary series of patients with HPV-related, bxproven oropharyngeal SCC at a single Institution. Materials/Methods: All patients treated with definitive combined chemoradiotherapy for T1 - 2N2 - 3/T3 - 4N0 - 3 HPV-related oropharyngeal SCC from August 2007 to December 2009 were considered for analysis. p16 (IHC) and HPV (ISH) testing were routinely performed using a broad spectrum probe. Concomitant chemoradiotherapy consisted of dose-painting IMRT to 3 dose levels (70, 63, 58.1 Gy in 35 fxs over 7 weeks) and single-agent platinum chemotherapy; induction chemotherapy with TPF was considered for patients with T4 and/or N3 disease if medically fit. All patients were offered speech and swallowing evaluation and management as well as prophylactic PEG tube placement with encouragement to maintain oral intake. Actuarial curves were computed using the KM method and compared with log-rank test. Results: 65 patients were analyzed. Pt characteristics: 55 males (86.2%) and 10 females (13.8%); median age -56 yrs (30 - 75); smoking history: 31 (47.7%) never smoked; 22 (33.8%) former smokers, and 12 (18.5%) current smokers. All tumor specimens were p16 positive and 58/65 (89.2%) were HPV positive. Primary site was base of tongue -35 pts (53.8%); tonsil -28 pts (43.1%); pharyngeal wall -1 pt (1.5%) and soft palate -1 pt (1.5%). Most patients had early T stage disease (T1, 20 pts, 30.8%; T2, 27 pts, 41.5%; T3, 7 pts, 10.8%; T4, 11 pts, 16.9%). 56 patients (86.1%) had clinically involved neck nodes at presentation; of these, 5 underwent upfront neck dissection and all had ECE. Eight patients (12.3%) received induction chemotherapy. At a median follow up of 22.1 months (10.4 - 42.1 mths), 4 patients developed local and/or regional failure for an estimated 2-yr locoregional control (LRC) rate of 90.1 + 4.9%. Predictors of better LRC by univariate analysis were early T stage (T1 - 2, p = 0.013) and male sex (p\0.001). Surgical salvage was attempted in all LR failures for an ultimate LRC rate of 96.0 + 2.8% at 2 yrs. Four patients developed distant metastasis; 2-yr overall survival is 94.9 + 3.7%. PEG tube dependency rates were 10.5 + 3.9% and 5.3 + 4.2% at 1 and 2 yrs, respectively. Patients with early T stage (T1 - 2, p = 0.001) and with no symptoms at presentation (painless neck mass, p\0.001) had significantly shorter duration PEG tube dependency (maximum 9 months). Regarding xerostomia, the actuarial rate of bottle of water dependency at 2 yrs is 25.5 ± 6.7%. Conclusions: Chemoradiotherapy is a highly effective treatment option for HPV-related oropharyngeal SCC with minimal long term morbidity; patients with T3 - 4 disease are at higher risk of failure and less likely to regain functional swallowing capabilities. These data also suggest possible gender differences in tumor responsiveness to chemoradiation. Author Disclosure: G. Sanguineti: None. S. Marur: None. C. Gourin: None. W. Koch: None. W. Westra: None. N. Aygun: None. N. Agrawal: None. H. Starmer: None. A. Forastiere: None.
2611
Low-dose Fractionated Radiation (LDFRT) as a Chemopotentiator of Neoadjuvant Paclitaxel and Carboplatin for Locally Advanced Squamous Cell Carcinoma of the Head and Neck: 5 Year Results Of A Prospective Phase II Trial
J. F. Gleason1, M. Kudrimoti1, E. M. Van Meter1, M. Mohiuddin2, W. F. Regine3, J. Valentino1, S. M. Arnold1 1 3
University of Kentucky, Lexington, KY, 2King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, University of Maryland, Baltimore, MD
Purpose/Objective(s): LDFRT (\ 100 cGy) induces enhanced cell killing in-vitro via hyper-radiation sensitivity phenomenon, but has not been utilized clinically. A novel treatment approach was designed utilizing neoadjuvant LDFRT and chemotherapy (CMT) for locally advanced SCCHN. Materials/Methods: 40 patients with locally advanced SCCHN were prospectively enrolled on a phase II clinical trial and treated with induction paclitaxel (225mg/m2), carboplatin (AUC 6), and four 80 cGy fractions of radiation (XRT) (BID on Day 1 and 2). This sequence was repeated on Days 22 and 23. Patients were evaluated for response by clinical exam, endoscopy, and imaging. A multidisciplinary team then made decisions about definitive treatment following induction. Definitive therapy was determined based on response to induction.