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EP-1114: A feasibility study of concurrent cetuximab during induction chemotherapy and IMRT for stage IV head and neck cancer
S24 growth, perineural invasion, p21, COX -2, p53, E cadherin, VEGF, Bcl- 2 and Ki- 67expression. Multi-factorial study showed that the most probable relationship (p less than 0.06 ) with localrecurrence demostrated regular use of alcohol , comorbidities, tumor location , perineural invasion , the expression of proteins - p53, COX- 2 and E cadherin. Based on multivariate statistical analysis of the contribution of clinical, morphological and molecular predictors combined predictive model was developed (including a total of 15 factors). Conclusions: Cancer of the base of tongue is more radiosensitive and promising in terms of the radical conservative treatment. EP-1114 A feasibility study of concurrent cetuximab during induction chemotherapy and IMRT for stage IV head and neck cancer J.C. Lin1, W.Y. Wang2, S.A. Liu3, C.W. Twu3, P.J. Lin1, Y.C. Liu1 1 Taichung Veterans General Hospital, Department of Radiation Oncology, Taichung, Taiwan 2 Hung Kuang University, Department of Nursing, Taichung, Taiwan 3 Taichung Veterans General Hospital, Department of Otorhinolaryngology, Taichung, Taiwan
ESTRO 33, 2014 Acute and late toxicities are reported in table 1. Acute skin toxicity and neck edema were mostly detected in the adjuvant radiotherapy group, while dysphagia G1-2, mucositis G3-4 and dry mouth were mostly registered in RR group. Late skin toxicity and neck edema incidence is higher in the adjuvant radiotherapy group; that of mild laryngeal edema and dry mouth in the RR group. Univariate analysis of survival (log rank test) for all endpoints confirmed the role of T, N and clinical stage as prognostic factors. There was no significant difference in disease free survival (DFS, LRFS, NRFS and MFS) between the different treatment modalities. At multivariate analysis (Cox Regression) nodal involvement at presentation was the only factor useful to predict disease-free survival. 21 pts underwent salvage total laryngectomy: 18 after RR and 3 after SHLR (p=NS) (Figure 1).
Purpose/Objective: To evaluate the feasibility of adding cetuximab during the whole course of induction chemotherapy (IndCT) + intensitymodulated radiotherapy (IMRT) for patients with stage IV squamous cell carcinoma of head and neck (SCCHN). Materials and Methods: The IndCT consists of cisplatin 60 mg/m2, alternating with 5-fluorouracil 2500 mg/m2 plus leucovorin 250 mg/m2 by an outpatient weekly schedule for a total of 10 weeks. IMRT 70 Gy/35 fractions were delivered to the original primary tumor and metastatic nodal region. Cetuximab 400 mg/m2 day 1, then 250 mg/m2 were administered every week during the whole chemoradiotherapy period. Results: Twenty-three patients were recruited. Patient compliance is good. Grade 3/4 toxicity during cetuximab-IndCT phase included leucopenia (0%), anemia (17.4%), thrombocytopenia (8.7%), vomiting (4.3%), mucositis (4.3%) and skin rash (17.4%). Response evaluated after cetuximab-IndCT showed 39.1% complete response, 47.8% partial response, and stable disease 13.1%. After cetuximab-IMRT, we observed 77.3% complete response, 18.2% partial response, and 4.5% stable disease. The major side effects during cetuximab-IMRT phase were 77.3% grade 3/4 mucositis and 45.4% grade 3/4 radiation dermatitis. All 23 patients could finish 10 weekly cetuximab during IndCT smoothly but 17/22 patients completed 7 weekly cetuximab during IMRT. One patient with stable disease after cetuximab-IndCT refused cetuximab-IMRT and shifted to surgery. Conclusions: Concurrent cetuximab, in combination with IndCT-IMRT is feasible with high response rate in patients with stage IV SCCHN. EP-1115 Clinical outcomes and toxicity in supraglottic laryngeal cancer treated with radical or adjuvant radiotherapy S. Pedretti1, L. Costa2, F. Foscarini1, S. Ciccarelli1, G. Pascale1, L. Pegurri2, N. Pasinetti2, S. Tonoli2, M. Buglione1, S.M. Magrini1 1 Brescia University, Radiation Oncology, Brescia, Italy 2 Spedali Civili di Brescia, Radiation Oncology, Brescia, Italy Purpose/Objective: To analyze clinical outcomes, acute and late toxicity, survival and laryngeal preservation, after different treatment for patients with supraglottic laryngeal cancer: radiotherapy alone (RR), radiotherapy after supraglottic horizontal laryngectomy (SHLR) and radiotherapy after total laryngectomy (TLR). Materials and Methods: From 1984 to 2012 708 patients (pts) were treated at Radiation Oncology Department of Spedali Civili - Brescia: 324 with RR, 126 with SHLR and 258 with TLR. 3 pts were excluded from analysis because T4 and subjected to not adequate SHLR. The acute and late toxicity (CTCAE v.4.0) were analyzed and related with radiotherapy purpose (χ2 test). Survival and laryngeal preservation were correlated with other known prognostic factors. Results: pts undergoing RR were older (p= 0.001), had worse PS (p= 0.000) and more comorbidity (p= 0.003) than the others. Pts undergoing TLR had more frequently locally advanced disease (T3-T4 52%) and nodal involvement (N+ 77%) (p=0.000), while pts treated with SHLR had smaller tumors (T2 63%) with cervical adenopathy (71%). 526, 157 and 22 pts had respectively 2D, 3D and IMRT treatment. Only 78 pts had concomitant chemotherapy with weekly CDDP (40mg/m2. RT doses on T and N were significantly higher in pts treated with RR (p= 0.000). The pattern of recurrence analysis showed no significant difference in the incidence of local or nodal recurrence.
Conclusions: In this historical series, radiotherapy, alone or in combination with chemotherapy, provides loco-regional control comparable to combined treatments (both after conservative and demolitive surgery), with no increase in severe late toxicity and allowing larynx preservation.
ESTRO 33, 2014 Acute and late toxicities are reported in table 1. Acute skin toxicity and neck edema were mostly detected in the adjuvant radiotherapy group, while dysphagia G1-2, mucositis G3-4 and dry mouth were mostly registered in RR group. Late skin toxicity and neck edema incidence is higher in the adjuvant radiotherapy group; that of mild laryngeal edema and dry mouth in the RR group. Univariate analysis of survival (log rank test) for all endpoints confirmed the role of T, N and clinical stage as prognostic factors. There was no significant difference in disease free survival (DFS, LRFS, NRFS and MFS) between the different treatment modalities. At multivariate analysis (Cox Regression) nodal involvement at presentation was the only factor useful to predict disease-free survival. 21 pts underwent salvage total laryngectomy: 18 after RR and 3 after SHLR (p=NS) (Figure 1).
Purpose/Objective: To evaluate the feasibility of adding cetuximab during the whole course of induction chemotherapy (IndCT) + intensitymodulated radiotherapy (IMRT) for patients with stage IV squamous cell carcinoma of head and neck (SCCHN). Materials and Methods: The IndCT consists of cisplatin 60 mg/m2, alternating with 5-fluorouracil 2500 mg/m2 plus leucovorin 250 mg/m2 by an outpatient weekly schedule for a total of 10 weeks. IMRT 70 Gy/35 fractions were delivered to the original primary tumor and metastatic nodal region. Cetuximab 400 mg/m2 day 1, then 250 mg/m2 were administered every week during the whole chemoradiotherapy period. Results: Twenty-three patients were recruited. Patient compliance is good. Grade 3/4 toxicity during cetuximab-IndCT phase included leucopenia (0%), anemia (17.4%), thrombocytopenia (8.7%), vomiting (4.3%), mucositis (4.3%) and skin rash (17.4%). Response evaluated after cetuximab-IndCT showed 39.1% complete response, 47.8% partial response, and stable disease 13.1%. After cetuximab-IMRT, we observed 77.3% complete response, 18.2% partial response, and 4.5% stable disease. The major side effects during cetuximab-IMRT phase were 77.3% grade 3/4 mucositis and 45.4% grade 3/4 radiation dermatitis. All 23 patients could finish 10 weekly cetuximab during IndCT smoothly but 17/22 patients completed 7 weekly cetuximab during IMRT. One patient with stable disease after cetuximab-IndCT refused cetuximab-IMRT and shifted to surgery. Conclusions: Concurrent cetuximab, in combination with IndCT-IMRT is feasible with high response rate in patients with stage IV SCCHN. EP-1115 Clinical outcomes and toxicity in supraglottic laryngeal cancer treated with radical or adjuvant radiotherapy S. Pedretti1, L. Costa2, F. Foscarini1, S. Ciccarelli1, G. Pascale1, L. Pegurri2, N. Pasinetti2, S. Tonoli2, M. Buglione1, S.M. Magrini1 1 Brescia University, Radiation Oncology, Brescia, Italy 2 Spedali Civili di Brescia, Radiation Oncology, Brescia, Italy Purpose/Objective: To analyze clinical outcomes, acute and late toxicity, survival and laryngeal preservation, after different treatment for patients with supraglottic laryngeal cancer: radiotherapy alone (RR), radiotherapy after supraglottic horizontal laryngectomy (SHLR) and radiotherapy after total laryngectomy (TLR). Materials and Methods: From 1984 to 2012 708 patients (pts) were treated at Radiation Oncology Department of Spedali Civili - Brescia: 324 with RR, 126 with SHLR and 258 with TLR. 3 pts were excluded from analysis because T4 and subjected to not adequate SHLR. The acute and late toxicity (CTCAE v.4.0) were analyzed and related with radiotherapy purpose (χ2 test). Survival and laryngeal preservation were correlated with other known prognostic factors. Results: pts undergoing RR were older (p= 0.001), had worse PS (p= 0.000) and more comorbidity (p= 0.003) than the others. Pts undergoing TLR had more frequently locally advanced disease (T3-T4 52%) and nodal involvement (N+ 77%) (p=0.000), while pts treated with SHLR had smaller tumors (T2 63%) with cervical adenopathy (71%). 526, 157 and 22 pts had respectively 2D, 3D and IMRT treatment. Only 78 pts had concomitant chemotherapy with weekly CDDP (40mg/m2. RT doses on T and N were significantly higher in pts treated with RR (p= 0.000). The pattern of recurrence analysis showed no significant difference in the incidence of local or nodal recurrence.
Conclusions: In this historical series, radiotherapy, alone or in combination with chemotherapy, provides loco-regional control comparable to combined treatments (both after conservative and demolitive surgery), with no increase in severe late toxicity and allowing larynx preservation.