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EP-1092: Perioperative high dose rate brachytherapy in previously irradiated head and neck cancer: Results
S600 ESTRO 36 _______________________________________________________________________________________________
Material and Methods Between September 2008 and May 2012, 59 patients, with locally advanced stage III and IV squamous cell carcinoma of head & neck cancer, received three courses of induction chemotherapy with docetaxel (75 mg/mq), cisplatin (75 mg/mq) and 5-fluoruracil (750 mg/mq/day on days 1-5) followed by radiotherapy plus two or three cycles of concurrent cisplatin 100 mg/mq (Group A). Twenty-nine of this patients received low dose radiotherapy concomitantly to induction chemotherapy (Group B). Treatment courses, hematological data and other parameters were also investigated. Results Three cycles of ICT were administered in all patients: only one (Group B) received two cycle because of high hematological toxicity. After neoadjuvant therapy completation, clinical tumor response was observed in 49 patients (83%); patients undergone low dose radiotherapy showed better complete remission (p=0.08). Grade > 3 toxicity with dose reduction occurred in 5 patients (8%). Median time from the final cycle of TPF to starting radiotherapy was 21 days. All patients received radical radiotherapy; one, two and three cycles of concurrent cisplatin was delivered in 0 (0.0%), 17 (58.6%), 10 (41.4%) patients of Group A and 1 (3.5%), 28 (96.5%), 0 (0.0%) patients of Group B, respectively. With a median followup of 28 months (range 2-58), one-year local control was 66% and 81% for Group A and Group B, respectively (p=0.05). No difference was observed in terms of overall survival and disease free-survival between the two groups (p=0.9 and 0.8). Toxicity during chemo-radiation was acceptable in both groups without difference, specially, in terms of hematological toxicity (p=0.76). But we found a correlation between hematological toxicity > G3 and local control (p=0.03). Conclusion Low dose radiotherapy in association with ICT prior to CRT, even if it is not the standard, could be considered tolerable, with encouraging efficacy in terms of response and local control, in locally advanced head and neck squamous cell carcinoma. Further investigation is warrented to confirm these data. EP-1092 Perioperative high dose rate brachytherapy in previously irradiated head and neck cancer: Results M.I. Martinez Fernandez1, M. Cambeiro1, J. Alcalde2, R. Martínez-Monge1 1 Clinica Universitaria de Navarra, Departament of Oncology, Pamplona, Spain 2 Clinica Universitaria de Navarra, Departament of Otolaryngology, Pamplona, Spain Purpose or Objective This study was undertaken to determine the feasibility of salvage surgery and perioperative high dose rate brachytherapy (PHDRB) in patients with previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field. Material and Methods Sixty-three patients were treated with surgical resection and perioperative high dose rate brachytherapy (PHDRB). The PHDRB dose was 4 Gy b.i.d. x 8 (32 Gy) for R0 resections (surgical margins equal to or greater than 10 mm) and 4 Gy b.i.d x 10 (40 Gy) for R1 resections (close or microscopically positive surgical margins, or the presence of extra- capsular nodal extension), respectively. Further external beam radiotherapy or chemotherapy was not given. Results Resections were categorized as R0 in 7 patients (11.1%) and R1 in 56 patients (88.9%). Thirty-four patients with R1 resections (54.0%) had microscopically positive margins, and 22 patients (34.9%) had close margins. Thirty-two
patients (50.8%) developed RTOG grade 3 or greater adverse events including 3 fatal events. After a median follow-up of 6.8 years, the 5-year locoregional control rate and 5-year overall survival rates were 55.0% and 35.6%, respectively. Conclusion Surgical resection and PHDRB is a successful treatment strategy in selected patients with previously irradiated head and neck cancer. Long-term locoregional control can be achieved in a substantial number of cases despite a high rate of inadequate surgical resections although at the expense of substantial toxicity. EP-1093 Hypofractioned robotic stereotactic radiotherapy of Head and neck Paragangliomas F. Meniai-Merzouki1, B. Coche-Dequeant1, E. Bogart2, T. Lacornerie3, X. Mirabel1, E. Lartigau1,4, D. Pasquier1,5 1 Centre Oscar Lambret, Radiation oncology, Lille, France 2 Centre Oscar Lambret, Biostatistics departement, Lille, France 3 Centre Oscar Lambret, Medical Physics, Lille, France 4 Cristal Cnrs, Umr 9181, Villeneuve D'ascq, France 5 Cristal Cnrs, UMR 9181, Villeneuve d'Ascq, France Purpose or Objective The aim of this study was to evaluate the outcomes of hypofractionated robotic stereotactic radiotherapy for paraganglioma (PGL) of the head and neck region Material and Methods We retrospectively studied 10 patients with benign head and neck PGL(s), treated with robotic hRST using Cyberknife at Oscar Lambert center between December 2008 and November 2012. Three of these patients were diagnosed with recurrent tumors after surgery. The median time to recurrence after surgery was 42 months. None of them was embolised before radiotherapy. The median follow-up was 49,2 months (range: 3-80,4 months). Results Eight patients presented with jugular-bulb PGL, 1 patient with jugular-carotid body PGL and 1 patient with cerebral posterior fossa PGL. The female/male ratio was 4/1. The median tumor volume was 12,91 cm3 (range: 0,89141,51). The median dose was 36 Gy (range: 21-40). The median number of fractions was 9 (range: 3-10).The tumor growth and clinical outcome were evaluated every 6 months in the 2 years and then annually. The 1 and 3 year freedom from disease progression was 100% and 88% respectively. PGLs were stable in 8 patients, and partial response was observed in 2 patients. No toxicity was observed. Conclusion According to our early experience, robotic stereotactic radiotherapy with Cyberknife seems to be successful treatment option in management of head and neck PGL EP-1094 Transoral Laser Microsurgery associated to Radiotherapy in advanced laryngeal carcinomas. I. Nieto Regueira1, V. Ochagavia2, A. Nuñez2, C. Ponte2, V. Muñoz2 1 Hospital do Meixoeiro. Complejo Hospitalario Universitario de Vigo, Radiation Oncology, Vigo, Spain 2 Hospital do Meixoeiro. CHUVI, Radiation Oncology, Vigo, Spain Purpose or Objective Transoral Laser Microsurgery is a surgical option treatment that seems to have similar results to radiotherapy with or without chemotherapy and offers similar outcomes in local control and survival compared with open surgery, preserving the larynx and its function.
Material and Methods Between September 2008 and May 2012, 59 patients, with locally advanced stage III and IV squamous cell carcinoma of head & neck cancer, received three courses of induction chemotherapy with docetaxel (75 mg/mq), cisplatin (75 mg/mq) and 5-fluoruracil (750 mg/mq/day on days 1-5) followed by radiotherapy plus two or three cycles of concurrent cisplatin 100 mg/mq (Group A). Twenty-nine of this patients received low dose radiotherapy concomitantly to induction chemotherapy (Group B). Treatment courses, hematological data and other parameters were also investigated. Results Three cycles of ICT were administered in all patients: only one (Group B) received two cycle because of high hematological toxicity. After neoadjuvant therapy completation, clinical tumor response was observed in 49 patients (83%); patients undergone low dose radiotherapy showed better complete remission (p=0.08). Grade > 3 toxicity with dose reduction occurred in 5 patients (8%). Median time from the final cycle of TPF to starting radiotherapy was 21 days. All patients received radical radiotherapy; one, two and three cycles of concurrent cisplatin was delivered in 0 (0.0%), 17 (58.6%), 10 (41.4%) patients of Group A and 1 (3.5%), 28 (96.5%), 0 (0.0%) patients of Group B, respectively. With a median followup of 28 months (range 2-58), one-year local control was 66% and 81% for Group A and Group B, respectively (p=0.05). No difference was observed in terms of overall survival and disease free-survival between the two groups (p=0.9 and 0.8). Toxicity during chemo-radiation was acceptable in both groups without difference, specially, in terms of hematological toxicity (p=0.76). But we found a correlation between hematological toxicity > G3 and local control (p=0.03). Conclusion Low dose radiotherapy in association with ICT prior to CRT, even if it is not the standard, could be considered tolerable, with encouraging efficacy in terms of response and local control, in locally advanced head and neck squamous cell carcinoma. Further investigation is warrented to confirm these data. EP-1092 Perioperative high dose rate brachytherapy in previously irradiated head and neck cancer: Results M.I. Martinez Fernandez1, M. Cambeiro1, J. Alcalde2, R. Martínez-Monge1 1 Clinica Universitaria de Navarra, Departament of Oncology, Pamplona, Spain 2 Clinica Universitaria de Navarra, Departament of Otolaryngology, Pamplona, Spain Purpose or Objective This study was undertaken to determine the feasibility of salvage surgery and perioperative high dose rate brachytherapy (PHDRB) in patients with previously irradiated, recurrent head and neck cancer or second primary tumors arising in a previously irradiated field. Material and Methods Sixty-three patients were treated with surgical resection and perioperative high dose rate brachytherapy (PHDRB). The PHDRB dose was 4 Gy b.i.d. x 8 (32 Gy) for R0 resections (surgical margins equal to or greater than 10 mm) and 4 Gy b.i.d x 10 (40 Gy) for R1 resections (close or microscopically positive surgical margins, or the presence of extra- capsular nodal extension), respectively. Further external beam radiotherapy or chemotherapy was not given. Results Resections were categorized as R0 in 7 patients (11.1%) and R1 in 56 patients (88.9%). Thirty-four patients with R1 resections (54.0%) had microscopically positive margins, and 22 patients (34.9%) had close margins. Thirty-two
patients (50.8%) developed RTOG grade 3 or greater adverse events including 3 fatal events. After a median follow-up of 6.8 years, the 5-year locoregional control rate and 5-year overall survival rates were 55.0% and 35.6%, respectively. Conclusion Surgical resection and PHDRB is a successful treatment strategy in selected patients with previously irradiated head and neck cancer. Long-term locoregional control can be achieved in a substantial number of cases despite a high rate of inadequate surgical resections although at the expense of substantial toxicity. EP-1093 Hypofractioned robotic stereotactic radiotherapy of Head and neck Paragangliomas F. Meniai-Merzouki1, B. Coche-Dequeant1, E. Bogart2, T. Lacornerie3, X. Mirabel1, E. Lartigau1,4, D. Pasquier1,5 1 Centre Oscar Lambret, Radiation oncology, Lille, France 2 Centre Oscar Lambret, Biostatistics departement, Lille, France 3 Centre Oscar Lambret, Medical Physics, Lille, France 4 Cristal Cnrs, Umr 9181, Villeneuve D'ascq, France 5 Cristal Cnrs, UMR 9181, Villeneuve d'Ascq, France Purpose or Objective The aim of this study was to evaluate the outcomes of hypofractionated robotic stereotactic radiotherapy for paraganglioma (PGL) of the head and neck region Material and Methods We retrospectively studied 10 patients with benign head and neck PGL(s), treated with robotic hRST using Cyberknife at Oscar Lambert center between December 2008 and November 2012. Three of these patients were diagnosed with recurrent tumors after surgery. The median time to recurrence after surgery was 42 months. None of them was embolised before radiotherapy. The median follow-up was 49,2 months (range: 3-80,4 months). Results Eight patients presented with jugular-bulb PGL, 1 patient with jugular-carotid body PGL and 1 patient with cerebral posterior fossa PGL. The female/male ratio was 4/1. The median tumor volume was 12,91 cm3 (range: 0,89141,51). The median dose was 36 Gy (range: 21-40). The median number of fractions was 9 (range: 3-10).The tumor growth and clinical outcome were evaluated every 6 months in the 2 years and then annually. The 1 and 3 year freedom from disease progression was 100% and 88% respectively. PGLs were stable in 8 patients, and partial response was observed in 2 patients. No toxicity was observed. Conclusion According to our early experience, robotic stereotactic radiotherapy with Cyberknife seems to be successful treatment option in management of head and neck PGL EP-1094 Transoral Laser Microsurgery associated to Radiotherapy in advanced laryngeal carcinomas. I. Nieto Regueira1, V. Ochagavia2, A. Nuñez2, C. Ponte2, V. Muñoz2 1 Hospital do Meixoeiro. Complejo Hospitalario Universitario de Vigo, Radiation Oncology, Vigo, Spain 2 Hospital do Meixoeiro. CHUVI, Radiation Oncology, Vigo, Spain Purpose or Objective Transoral Laser Microsurgery is a surgical option treatment that seems to have similar results to radiotherapy with or without chemotherapy and offers similar outcomes in local control and survival compared with open surgery, preserving the larynx and its function.