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EP-1363: Prospective analysis of radical chemoirradiation for head and neck cancer in elderly [ Age = 65years] using IMRT
ESTRO 33, 2014
ELECTRONIC POSTER: CLINICAL TRACK: ELDERLY EP-1362 Intensity modulated radiotherapy and endocavitary BRT in elderly patients with locally advanced cervical cancer G. Vidano1, F. Giannelli1, G. Blandino1, G. Timon1, S. Garelli2, S. Agostinelli2, S. Barra1, R. Corvò1 1 IRCCS San Martino IST, Radiation Oncology, Genova, Italy 2 IRCCS San Martino IST, Medical Physics, Genova, Italy Purpose/Objective: The aim of our study was to report the feasibility of radical radiotherapy in locally advanced cervical carcinoma treated by external beam radiotherapy (EBRT) and high dose rate (HDR) endocavitary brachytherapy (BRT) in patients ≥70 years old. Materials and Methods: We included 18 pts ≥ 70years old (range 71-86, median 80), affected by locally advanced cervical cancer, from 2010 to 2013. The FIGO stages were IB2, IIA, IIB, IIIA, IIIB in 2 pts (11%), 1 pt (5,5%), 12 pts (67%), 2 pts (11%) and 1 pt (5,5%), respectively. The histological analysis showed squamous cell carcinoma in all pts. All pts were treated by a combination of EBRT and HDR endocavitary BRT; 13 pts (72%) received concomitant chemotherapy (Cisplatin 40 mg/mq weekly). Each pt received 45-50 Gy of EBRT to the pelvis followed by a parametrial boost (total dose 53.75-66.4 Gy) in the pts with disease extension to the parametrium or the pelvic side wall (14 pts, 78%). In 3 pts (17%) was used 3D technique while Helical Tomotherapy was used in 15 pts (83%). After pelvic radiotherapy each pt also underwent 4 or 5 applications of high dose rate BRT, twice a week: the first group of pts (group A) received 24 Gy/4 fx/6 Gy (7 pts, 39 %), the subsequent 5 pts (28%) received 28 Gy/4 fx/7 Gy (group B) and the last 6 pts (33%) 30 Gy/5 fx/ 6 Gy (group C). A MR based BRT planning was used for all treatment, using MR compatible applicators. The median follow up was 18 months (range 4-39 months). Results: The median biologically equivalent dose in 2 Gy fractions (EQD2) referred to HRCTV (high risk clinical target volume), rectum (2 cc) and bladder (2 cc), is indicated in Table 1.
S109 Conclusions: According to our results, the combined radiation therapy (EBRT+HDRBRT) in elderly pts (age ≥ 70 years) turned out to be a safe and effective therapeutical approach: the low rates of acute toxicity in the first group of pts allowed a HDRBRT dose escalation without an increase of adverse effects. HDRBRT dose of 30 Gy/5 fx/ 6 Gy is presently the reference fractionation adopted after EBRT for the the treatment of elderly pts. EP-1363 Prospective analysis of radical chemoirradiation for head and neck cancer in elderly [ Age = 65years] using IMRT R. Jomon1, T. Thanuja1, P.C. Sudheeran1, C.D. Joseph1 1 Amala Cancer Hospital & Research Center, Oncology, Trichur, India Purpose/Objective: 1) To assess the compliance, tolerance and feasibility of radical concurrent chemoirradiation for head and neck cancer in elderly patients [age ≥65 yrs] using Intensity Modulated Radiotherapy[IMRT]. 2) To evaluate the major toxicities and response of concurrent chemoirradiation in elderly patients. Materials and Methods: Elderly patients aged 65 years or above registered in oncology outpatient unit during the period January 2011 to July 2013, with newly diagnosed Stage III or IV squamous cell carcinoma head and neck, with performance status ECOG 0-1, and satisfying inclusion criteria were selected. External Radiotherapy dose 66Gy to 70Gy in 30 to 35 fractions[5#/week] along with concurrent chemotherapy Cisplatin 40mg/sq.m given in a weekly basis. Local and systemic toxicities were assessed during treatment every week according to RTOG criteria. Response assessment done at the end of treatment and during subsequent follow-ups. Results: Thirty one eligible patients were selected for study,mean age of the patient group was 70 years, 84% of them completed planned radical dose of radiotherapy, out of which 87% patients tolerated 4 or more cycles of concurrent chemotherapy. Average gap during treatment was 3 days. Grade III skin reaction[32%], mucositis [58%] and dysphagia [45%] were the major toxicities observed. None of the patients developed Grade II or III neutropenia. Lower respiratory tract infection was observed in 12%. Among patients who completed treatment, 86% had achieved complete response. 2Gy/ # was the most tolerated fractionation schedule [51%]. Conclusions: Elderly patients with age more than 65 years, IMRT is a feasible option for radical chemoirradiation in head and neck cancer.Response rate and loco regional toxicities are comparable with other standard studies. Long term benefits and late complications have to be studied in detail.
Acute toxicity (RTOG scale) is summarized in Table 2.
EP-1364 Concurrent radio-chemotherapy in elderly patients: Feasibility and tolerance in a mono-institutional experience M. Di Genesio Pagliuca1, G. Apicella1, A. Galla1, M. Guffi1, L. Donis1, M. Paolini1, V. Amisano1, S. Torrente1, I. Manfredda1, M. Krengli1 1 University Hospital Maggiore della Carità, Radiotherapy, Novara, Italy Purpose/Objective: Improvements in general health care and increased life expectancy have resulted in more elderly cancer patients. The aim of our study is to evaluate feasibility and tolerance of chemoradiotherapy (CRT) in elderly patients with advanced cancer. Materials and Methods: Clinical records of patients (pts) >70 years who underwent CRT at a our Institution between January 2005 and June 2013 were reviewed. CRT treatment was evaluated in terms of dose of radiotherapy (RT), dose and type of chemotherapy (CT), and compliace as treatment interruptions or dose modifications. Performance status (KPS) and Charlson comorbidity index (CI) were also calculated, and their correlation with acute toxicity (scored according to CTCAE v.3 scale) was investigated.
All pts completed the treatment without interruption, with the only exceptions of one pt of group B and one pt of group C, who required a break of 5 days due to grade 3 gastrointestinal and haematological effects respectively. The outcome resulted as follows:14 pts (78%) showed a complete response (4 pts of group A, 57%; 5 pts of group B, 100%; 5 pts of group C, 83%),1 pt (6%) of group A had a partial response, 2 pts (11%) presented a systemic progression disease three months after the end of treatment and 1 pt (6%) died for unrelated causes. No pts showed loco-regional recurrences.
Results: Overall, 118 out of 9,654 pts (1.2%), 71 males (60%) and 47 females (40%), with median age 78 years (range 70-90) were analyzed. Stages and histology are summarized in Table 1. Median KPS was 85 (range 80-100) and median CI was 4.5 (range 2-7). CRT was administered with neoadjuvant (42.3%), curative (29.5%), adjuvant (25.5%) and palliative (2.5%) intent. Ten pts (8.5%) received neoadjuvant chemotherapy (CT). Scheduled dose of RT was delivered to 114 (96.5%) pts. Four pts (3.5%) definitively stopped RT course: one (stomach cancer) had bowel obstruction; one (oesophageal cancer) developed brain metastases; one (rectal cancer) because of G3 GI toxicity; one oesophageal cancer because of hematemesis. According to tumour type, the following chemotherapeutic agents were administered: platinum compounds in 12 pts (10.2%), fluoropirimidynes in 70 pts (59%), polichemotherapy in 28 pts (24.7%), biological drugs in 4 (3.5%) pts,
ELECTRONIC POSTER: CLINICAL TRACK: ELDERLY EP-1362 Intensity modulated radiotherapy and endocavitary BRT in elderly patients with locally advanced cervical cancer G. Vidano1, F. Giannelli1, G. Blandino1, G. Timon1, S. Garelli2, S. Agostinelli2, S. Barra1, R. Corvò1 1 IRCCS San Martino IST, Radiation Oncology, Genova, Italy 2 IRCCS San Martino IST, Medical Physics, Genova, Italy Purpose/Objective: The aim of our study was to report the feasibility of radical radiotherapy in locally advanced cervical carcinoma treated by external beam radiotherapy (EBRT) and high dose rate (HDR) endocavitary brachytherapy (BRT) in patients ≥70 years old. Materials and Methods: We included 18 pts ≥ 70years old (range 71-86, median 80), affected by locally advanced cervical cancer, from 2010 to 2013. The FIGO stages were IB2, IIA, IIB, IIIA, IIIB in 2 pts (11%), 1 pt (5,5%), 12 pts (67%), 2 pts (11%) and 1 pt (5,5%), respectively. The histological analysis showed squamous cell carcinoma in all pts. All pts were treated by a combination of EBRT and HDR endocavitary BRT; 13 pts (72%) received concomitant chemotherapy (Cisplatin 40 mg/mq weekly). Each pt received 45-50 Gy of EBRT to the pelvis followed by a parametrial boost (total dose 53.75-66.4 Gy) in the pts with disease extension to the parametrium or the pelvic side wall (14 pts, 78%). In 3 pts (17%) was used 3D technique while Helical Tomotherapy was used in 15 pts (83%). After pelvic radiotherapy each pt also underwent 4 or 5 applications of high dose rate BRT, twice a week: the first group of pts (group A) received 24 Gy/4 fx/6 Gy (7 pts, 39 %), the subsequent 5 pts (28%) received 28 Gy/4 fx/7 Gy (group B) and the last 6 pts (33%) 30 Gy/5 fx/ 6 Gy (group C). A MR based BRT planning was used for all treatment, using MR compatible applicators. The median follow up was 18 months (range 4-39 months). Results: The median biologically equivalent dose in 2 Gy fractions (EQD2) referred to HRCTV (high risk clinical target volume), rectum (2 cc) and bladder (2 cc), is indicated in Table 1.
S109 Conclusions: According to our results, the combined radiation therapy (EBRT+HDRBRT) in elderly pts (age ≥ 70 years) turned out to be a safe and effective therapeutical approach: the low rates of acute toxicity in the first group of pts allowed a HDRBRT dose escalation without an increase of adverse effects. HDRBRT dose of 30 Gy/5 fx/ 6 Gy is presently the reference fractionation adopted after EBRT for the the treatment of elderly pts. EP-1363 Prospective analysis of radical chemoirradiation for head and neck cancer in elderly [ Age = 65years] using IMRT R. Jomon1, T. Thanuja1, P.C. Sudheeran1, C.D. Joseph1 1 Amala Cancer Hospital & Research Center, Oncology, Trichur, India Purpose/Objective: 1) To assess the compliance, tolerance and feasibility of radical concurrent chemoirradiation for head and neck cancer in elderly patients [age ≥65 yrs] using Intensity Modulated Radiotherapy[IMRT]. 2) To evaluate the major toxicities and response of concurrent chemoirradiation in elderly patients. Materials and Methods: Elderly patients aged 65 years or above registered in oncology outpatient unit during the period January 2011 to July 2013, with newly diagnosed Stage III or IV squamous cell carcinoma head and neck, with performance status ECOG 0-1, and satisfying inclusion criteria were selected. External Radiotherapy dose 66Gy to 70Gy in 30 to 35 fractions[5#/week] along with concurrent chemotherapy Cisplatin 40mg/sq.m given in a weekly basis. Local and systemic toxicities were assessed during treatment every week according to RTOG criteria. Response assessment done at the end of treatment and during subsequent follow-ups. Results: Thirty one eligible patients were selected for study,mean age of the patient group was 70 years, 84% of them completed planned radical dose of radiotherapy, out of which 87% patients tolerated 4 or more cycles of concurrent chemotherapy. Average gap during treatment was 3 days. Grade III skin reaction[32%], mucositis [58%] and dysphagia [45%] were the major toxicities observed. None of the patients developed Grade II or III neutropenia. Lower respiratory tract infection was observed in 12%. Among patients who completed treatment, 86% had achieved complete response. 2Gy/ # was the most tolerated fractionation schedule [51%]. Conclusions: Elderly patients with age more than 65 years, IMRT is a feasible option for radical chemoirradiation in head and neck cancer.Response rate and loco regional toxicities are comparable with other standard studies. Long term benefits and late complications have to be studied in detail.
Acute toxicity (RTOG scale) is summarized in Table 2.
EP-1364 Concurrent radio-chemotherapy in elderly patients: Feasibility and tolerance in a mono-institutional experience M. Di Genesio Pagliuca1, G. Apicella1, A. Galla1, M. Guffi1, L. Donis1, M. Paolini1, V. Amisano1, S. Torrente1, I. Manfredda1, M. Krengli1 1 University Hospital Maggiore della Carità, Radiotherapy, Novara, Italy Purpose/Objective: Improvements in general health care and increased life expectancy have resulted in more elderly cancer patients. The aim of our study is to evaluate feasibility and tolerance of chemoradiotherapy (CRT) in elderly patients with advanced cancer. Materials and Methods: Clinical records of patients (pts) >70 years who underwent CRT at a our Institution between January 2005 and June 2013 were reviewed. CRT treatment was evaluated in terms of dose of radiotherapy (RT), dose and type of chemotherapy (CT), and compliace as treatment interruptions or dose modifications. Performance status (KPS) and Charlson comorbidity index (CI) were also calculated, and their correlation with acute toxicity (scored according to CTCAE v.3 scale) was investigated.
All pts completed the treatment without interruption, with the only exceptions of one pt of group B and one pt of group C, who required a break of 5 days due to grade 3 gastrointestinal and haematological effects respectively. The outcome resulted as follows:14 pts (78%) showed a complete response (4 pts of group A, 57%; 5 pts of group B, 100%; 5 pts of group C, 83%),1 pt (6%) of group A had a partial response, 2 pts (11%) presented a systemic progression disease three months after the end of treatment and 1 pt (6%) died for unrelated causes. No pts showed loco-regional recurrences.
Results: Overall, 118 out of 9,654 pts (1.2%), 71 males (60%) and 47 females (40%), with median age 78 years (range 70-90) were analyzed. Stages and histology are summarized in Table 1. Median KPS was 85 (range 80-100) and median CI was 4.5 (range 2-7). CRT was administered with neoadjuvant (42.3%), curative (29.5%), adjuvant (25.5%) and palliative (2.5%) intent. Ten pts (8.5%) received neoadjuvant chemotherapy (CT). Scheduled dose of RT was delivered to 114 (96.5%) pts. Four pts (3.5%) definitively stopped RT course: one (stomach cancer) had bowel obstruction; one (oesophageal cancer) developed brain metastases; one (rectal cancer) because of G3 GI toxicity; one oesophageal cancer because of hematemesis. According to tumour type, the following chemotherapeutic agents were administered: platinum compounds in 12 pts (10.2%), fluoropirimidynes in 70 pts (59%), polichemotherapy in 28 pts (24.7%), biological drugs in 4 (3.5%) pts,