- Email: [email protected]
EP-1056: Radiation and concurrent superselective intra-arterial cisplatin for maxillary sinus cancer
S581 ESTRO 36 _______________________________________________________________________________________________
those with significant co-morbidities or a poor performance status (11.0%, n=14). Concurrent chemotherapy with cisplatin100mg/m2 or carboplatin AUC5 (when cisplatin contra-indicated), 3-4weekly, was considered in patients with extracapsular spread and/or involved margin (49.6% n=63) and given to those with no contra-indications (31.5%, n=40). Median follow up from the end of treatment was 20.7 months (range 0.9-76.8 months) in all patients. Median follow in survivors was 30.9 months (range 7.3-76.8 months). At the time of analysis 39 patients had a confirmed relapse and 52 patients had died (35 disease related). Mean survival rates were: OS 45.9 months (95% CI 39.8-52.1); DFS 43.5 months (95%CI 37.5-49.5); DSS 55.4 months (95% CI 49.4-61.3). One-year survival rates were: OS 74% (95%CI - 66.2 – 81.8); DFS 74% (95%CI – 66.2 – 81.8); DSS 79% (95%CI – 71.2 – 86.8). Three-year survival rates were: OS 54% (95%CI - 44.2 – 63.8); DFS 51% (95%CI – 41.2 – 60.8); DSS 66% (95%CI – 56.2 – 75.8). Conclusion Our results are consistent with nationally reported survival data. Ongoing work is carried out to report treatment related toxicities and identify histopathological factors that may influence prognosis. EP-1055 A Novel Postoperative Chemoradiotherapy Protocol versus Conventional CCRT for High-risk SCCHN Y.T. Shih1, W.Y. Wang2, C.T. Wu3, J.C. Lin4 1 St. Martin De Porres Hospital, Radiation Oncology Department, Chiayi, Taiwan 2 Hung Kuang University, Department of Nursing, Taichung, Taiwan 3 Changhua Show Chwan Memorial Hospital, Department of Radiation Oncology-, Changhua, Taiwan 4 Taichung Veterans General Hospital, Department of Radiation Oncology-, Taichung, Taiwan Purpose or Objective Postoperative concurrent chemoradiotherapy (CCRT) is supprior to RT alone for squamous cell carcinoma of the head and neck (SCCHN) with high-risk factors (such as extracapsular invasion, positive resection margin) by both RTOG 9501 and EORTC 22931 trials. We developed a new protocol of intensive chemotherapy followed by IMRT (IntCT+RT) and compared the toxicity and efficacy with CCRT for patients with SCCHN and poor prognostic factors after surgery. Material and Methods Ninety-two SCCHN patients who received curative resection first and with at least one of the following characteristics, resection margin involvement or close to the tumor, extracapsular invasion, perineural invasion, angiolymphatic invasion, pathological stage T4, and multiple neck nodes metastasis were eligible for this study. Postoperative multi-drugs combination chemotherapy (Methotrexate 30 mg/m2 d1, Epirubicin 30 mg/m2 d1, alternating with Mitomycin-C 4 mg/m2 d8, Oncovin 1 mg/m2 d8, Cisplatin 25 mg/m2 d8, Leucovorin 120 mg/m2 d8, 5-fluoroUracil 1000 mg/m2 d8, and Bleomycin 10 mg/m2 d8) for 10-12 weeks were administered followed by IMRT in the IntCT+RT groups. Patient in the CCRT group received similar RT and concurrent chemotherapy of either tri-weekly cisplatin 100mg/m2 alone or tri-weekly cisplatin 50mg/m2 plus oral tegafur-uracil 2# bid for 7 weeks. Results The IntCT+RT group (n=37) had less regional (8.1% vs. 12.7%) and distant (2.7% vs. 7.3%) failures, compared with the CCRT group (n=55). The Kaplan-Meier survival analyses revealed that patients treated by IntCT+RT had better regional failure-free survival (3-year rate, 94.5% vs. 72.4%, P=0.0294) and overall survival (75.9% vs. 61.8%, P=0.1343)
than those who received CCRT. Grade 3/4 acute toxicity of IntCT phase included leucopenia (51.4%), anemia (27.0%), vomiting (5.4%), alopecia (5.4%) and mucositis (2.7%) but patients could tolerate it well. During RT period, patients in the CCRT group had significantly higher grade 3/4 mucositis (76.4% vs. 57.7%, P=0.0356) and vomiting (27.3% vs. 0%, P<0.0001) than those in the IntCTRT group. Conclusion IntCT+RT in postoperative setting for high-risk SCCHN patients is feasible. We observe a significant better regional control, favorable overall survival and less grade 3 or 4 mucositis and vomiting in the IntCT-RT group compard with the CCRT. This novel approach deserves to be studied in a phase III randomized trial. EP-1056 Radiation and concurrent superselective intra-arterial cisplatin for maxillary sinus cancer T. Ebara1, K. Ando1, M. Kawahara1, M. Suzuki2, H. Horikoshi3, Y. Tamaki4 1 Gunma Prefectural Cancer Center, Division of Radiation Oncology, Ota, Japan 2 Gunma Prefectural Cancer Center, Division of Head and Neck Surgery, Ota, Japan 3 Gunma Prefectural Cancer Center, Division of Radiology, Ota, Japan 4 Tsukuba University Hospital, Department of Radiation Oncology, Tsukuba, Japan Purpose or Objective This study aimed to evaluate the efficacy of radiation and concomitant superselective high-dose intra-arterial cisplatin (RADPLAT) for maxillary sinus squamous carcinoma (MS-SCC). Material and Methods We conducted a retrospective chart review of MS-SCC patients treated with RADPLAT between 2008 and June 2016. Results Thirty-four MS-SCC patients were received RADPLAT. There were 9 patients (26%) diagnosed with T3, 14 (41%) with T4a, and 11 (32%) with T4b disease. Lymph-node involvement was present in 6 patients. Cisplatin with median 150 mg was administered using the superselective intra-arterial infusion method bi-weekly. Of them, 29, 3, 1 and 1 patients were received 4, 3, 2 and 1 times cisplatin infusions, respectively. Radiation, ranged with 50–74 Gy with median 60 Gy was administered by 2 Gy fraction in 5 times a week. The median follow-up was 24.6 months, ranged with 4.1-92.4 months. Complete responses in the primary site were obtained in 11 (32%) patients and partial responses in 19 (56%) patients. The 2 and 5-year overall survival rates (OS) were 66 and 45%, respectively. The 2 and 5-year primary-site recurrence free survival rates (PRFS) were 49 and 40%, respectively. The 2 and 5-year disease-free survival rates (DFS) were 45 and 37%, respectively. The patients with T3 showed significantly better OS (p=0.03). The patients with 4 time infusions showed significantly better OS, PRFS, and DFS (p<0.05). There was no life-threatening toxicity. Conclusion In RADPLAT for MS-SCC, 4 times cisplatin infusions could improve the prognosis. EP-1057 Predictive and prognostic value of pretreatment [18F] FDG-PET parameters in head-andneck cancer L. Deantonio1, M. Paolini1, E. Puta2, L. Vigna3, R. Matheoud3, L. Masini1, G. Sacchetti2, M. Brambilla3, M. Krengli1 1 University Hospital Maggiore della Carità, Radiotherapy, Novara, Italy
those with significant co-morbidities or a poor performance status (11.0%, n=14). Concurrent chemotherapy with cisplatin100mg/m2 or carboplatin AUC5 (when cisplatin contra-indicated), 3-4weekly, was considered in patients with extracapsular spread and/or involved margin (49.6% n=63) and given to those with no contra-indications (31.5%, n=40). Median follow up from the end of treatment was 20.7 months (range 0.9-76.8 months) in all patients. Median follow in survivors was 30.9 months (range 7.3-76.8 months). At the time of analysis 39 patients had a confirmed relapse and 52 patients had died (35 disease related). Mean survival rates were: OS 45.9 months (95% CI 39.8-52.1); DFS 43.5 months (95%CI 37.5-49.5); DSS 55.4 months (95% CI 49.4-61.3). One-year survival rates were: OS 74% (95%CI - 66.2 – 81.8); DFS 74% (95%CI – 66.2 – 81.8); DSS 79% (95%CI – 71.2 – 86.8). Three-year survival rates were: OS 54% (95%CI - 44.2 – 63.8); DFS 51% (95%CI – 41.2 – 60.8); DSS 66% (95%CI – 56.2 – 75.8). Conclusion Our results are consistent with nationally reported survival data. Ongoing work is carried out to report treatment related toxicities and identify histopathological factors that may influence prognosis. EP-1055 A Novel Postoperative Chemoradiotherapy Protocol versus Conventional CCRT for High-risk SCCHN Y.T. Shih1, W.Y. Wang2, C.T. Wu3, J.C. Lin4 1 St. Martin De Porres Hospital, Radiation Oncology Department, Chiayi, Taiwan 2 Hung Kuang University, Department of Nursing, Taichung, Taiwan 3 Changhua Show Chwan Memorial Hospital, Department of Radiation Oncology-, Changhua, Taiwan 4 Taichung Veterans General Hospital, Department of Radiation Oncology-, Taichung, Taiwan Purpose or Objective Postoperative concurrent chemoradiotherapy (CCRT) is supprior to RT alone for squamous cell carcinoma of the head and neck (SCCHN) with high-risk factors (such as extracapsular invasion, positive resection margin) by both RTOG 9501 and EORTC 22931 trials. We developed a new protocol of intensive chemotherapy followed by IMRT (IntCT+RT) and compared the toxicity and efficacy with CCRT for patients with SCCHN and poor prognostic factors after surgery. Material and Methods Ninety-two SCCHN patients who received curative resection first and with at least one of the following characteristics, resection margin involvement or close to the tumor, extracapsular invasion, perineural invasion, angiolymphatic invasion, pathological stage T4, and multiple neck nodes metastasis were eligible for this study. Postoperative multi-drugs combination chemotherapy (Methotrexate 30 mg/m2 d1, Epirubicin 30 mg/m2 d1, alternating with Mitomycin-C 4 mg/m2 d8, Oncovin 1 mg/m2 d8, Cisplatin 25 mg/m2 d8, Leucovorin 120 mg/m2 d8, 5-fluoroUracil 1000 mg/m2 d8, and Bleomycin 10 mg/m2 d8) for 10-12 weeks were administered followed by IMRT in the IntCT+RT groups. Patient in the CCRT group received similar RT and concurrent chemotherapy of either tri-weekly cisplatin 100mg/m2 alone or tri-weekly cisplatin 50mg/m2 plus oral tegafur-uracil 2# bid for 7 weeks. Results The IntCT+RT group (n=37) had less regional (8.1% vs. 12.7%) and distant (2.7% vs. 7.3%) failures, compared with the CCRT group (n=55). The Kaplan-Meier survival analyses revealed that patients treated by IntCT+RT had better regional failure-free survival (3-year rate, 94.5% vs. 72.4%, P=0.0294) and overall survival (75.9% vs. 61.8%, P=0.1343)
than those who received CCRT. Grade 3/4 acute toxicity of IntCT phase included leucopenia (51.4%), anemia (27.0%), vomiting (5.4%), alopecia (5.4%) and mucositis (2.7%) but patients could tolerate it well. During RT period, patients in the CCRT group had significantly higher grade 3/4 mucositis (76.4% vs. 57.7%, P=0.0356) and vomiting (27.3% vs. 0%, P<0.0001) than those in the IntCTRT group. Conclusion IntCT+RT in postoperative setting for high-risk SCCHN patients is feasible. We observe a significant better regional control, favorable overall survival and less grade 3 or 4 mucositis and vomiting in the IntCT-RT group compard with the CCRT. This novel approach deserves to be studied in a phase III randomized trial. EP-1056 Radiation and concurrent superselective intra-arterial cisplatin for maxillary sinus cancer T. Ebara1, K. Ando1, M. Kawahara1, M. Suzuki2, H. Horikoshi3, Y. Tamaki4 1 Gunma Prefectural Cancer Center, Division of Radiation Oncology, Ota, Japan 2 Gunma Prefectural Cancer Center, Division of Head and Neck Surgery, Ota, Japan 3 Gunma Prefectural Cancer Center, Division of Radiology, Ota, Japan 4 Tsukuba University Hospital, Department of Radiation Oncology, Tsukuba, Japan Purpose or Objective This study aimed to evaluate the efficacy of radiation and concomitant superselective high-dose intra-arterial cisplatin (RADPLAT) for maxillary sinus squamous carcinoma (MS-SCC). Material and Methods We conducted a retrospective chart review of MS-SCC patients treated with RADPLAT between 2008 and June 2016. Results Thirty-four MS-SCC patients were received RADPLAT. There were 9 patients (26%) diagnosed with T3, 14 (41%) with T4a, and 11 (32%) with T4b disease. Lymph-node involvement was present in 6 patients. Cisplatin with median 150 mg was administered using the superselective intra-arterial infusion method bi-weekly. Of them, 29, 3, 1 and 1 patients were received 4, 3, 2 and 1 times cisplatin infusions, respectively. Radiation, ranged with 50–74 Gy with median 60 Gy was administered by 2 Gy fraction in 5 times a week. The median follow-up was 24.6 months, ranged with 4.1-92.4 months. Complete responses in the primary site were obtained in 11 (32%) patients and partial responses in 19 (56%) patients. The 2 and 5-year overall survival rates (OS) were 66 and 45%, respectively. The 2 and 5-year primary-site recurrence free survival rates (PRFS) were 49 and 40%, respectively. The 2 and 5-year disease-free survival rates (DFS) were 45 and 37%, respectively. The patients with T3 showed significantly better OS (p=0.03). The patients with 4 time infusions showed significantly better OS, PRFS, and DFS (p<0.05). There was no life-threatening toxicity. Conclusion In RADPLAT for MS-SCC, 4 times cisplatin infusions could improve the prognosis. EP-1057 Predictive and prognostic value of pretreatment [18F] FDG-PET parameters in head-andneck cancer L. Deantonio1, M. Paolini1, E. Puta2, L. Vigna3, R. Matheoud3, L. Masini1, G. Sacchetti2, M. Brambilla3, M. Krengli1 1 University Hospital Maggiore della Carità, Radiotherapy, Novara, Italy