- Email: [email protected]
Experience With Combination of Nedaplatin Plus Docetaxel Chemotherapy and Intensity Modulated Radiation Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma
Poster Viewing Session E293
Volume 93 Number 3S Supplement 2015
2729 Proton Therapy for Sinonasal Mucosal Melanoma J.C. Greenwalt,1 R. Dagan,2 C.M. Bryant,3 C.G. Morris,1 and W.M. Mendenhall1; 1University of Florida, Gainesville, FL, 2 University of Florida, Jacksonville, FL, 3University of Florida Health Proton Therapy Institute, Jacksonville, FL Purpose/Objective(s): To report outcomes and toxicities in patients treated with primary or postoperative high-dose proton therapy (PT) for mucosal melanoma. Materials/Methods: We conducted an institutional review boarde approved retrospective medical record review of 7 adult patients treated for primary mucosal head and neck melanoma at our institute to determine their treatment outcomes. Seven patients with a median age of 60 years (range, 37-80) were treated with external beam PT. All 7 patients had mucosal melanoma. Primary tumor locations were the nasal cavity (nZ5), ethmoid sinus (nZ1), and maxillary sinus (nZ1). Six patients underwent gross total resection before PT and 1 patient underwent a biopsy due to unresectable disease from intracranial extension. In the postoperative setting, PT was initiated at a median of 53 days after surgery (range, 33-85). The primary target volume was defined as the surgical bed plus a margin for microscopic disease and setup uncertainties. The median PT dose to the primary high-risk planning target volume was 74.4 Gy (RBE) (range, 69.6-74.4). Six patients were treated with elective nodal radiation to the neck to a median dose of 50 Gy (range, 48-50). None of the patients had neoadjuvant, concurrent, or adjuvant chemotherapy. The outcomes evaluated were local control, distant metastasisfree survival, cause-specific survival, and overall survival. Complications were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Results: Median follow-up was 1.4 years from the end of PT (range, 0.5 to 6.6 years). The cause-specific survival and overall survival rates were equivalent at 83% at 1 year and 67% at 1.5 years. Three patients died of metastatic disease, and all died within 25 months of completing PT. One patient who was treated with 69.6 Gy (RBE) recurred locally at 2 months after completing PT and died of distant disease. The local-regional control rate at 1 and 1.5 years were both 86% while the freedom from distant metastases rate was 71% at 1 and 1.5 years. One patient experienced grade 2 epiphora and grade 4 visual toxicity, leading to loss of useful vision in the treated eye. One patient with brain necrosis was found to have developed brain metastases requiring steroids following PT. No patient was on thyroid replacement at the time of analysis, 2 patients reported grade 2 sinusitis, 1 patient had a grade 2 oral cavity fistula, and 1 patient reported grade 2 sensorineural hearing loss. No contralateral visual complications occurred. Conclusion: PT can be utilized to escalate the dose in sinonasal mucosal melanoma while sparing uninvolved optic structures and help preserve vision. Metastatic progression remains the dominant cause of treatment failure. Our data support that postoperative RT delivered to a dose above 70 Gy (RBE) may help increase local-regional control in this disease. Author Disclosure: J.C. Greenwalt: None. R. Dagan: None. C.M. Bryant: None. C.G. Morris: None. W.M. Mendenhall: None.
2730 Experience With Combination of Nedaplatin Plus Docetaxel Chemotherapy and Intensity Modulated Radiation Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma F. Wang; Tianjin Medical University Cancer Institute and Hospital, Tianjin, China Purpose/Objective(s): The aim was to evaluate the efficacy and toxicity of nedaplatin and docetaxel chemotherapy plus intensity modulated radiation therapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC).
Materials/Methods: Fifty patients diagnosed with locoregionally advanced NPC received IMRT plus neoadjuvant and adjuvant chemotherapy from February 2009 to December 2012. They were aged from 18 to 69 years; had pathologically confirmed diagnosis of WHO types II and III NPC; Stage III, IVA, and IVB. The IMRT technique was utilized for all patients. The gross target volume (GTV) included all known gross disease, and the planning GTV (PGTV) was created based on the GTV with an additional 5-mm margin. The clinical target volume (CTV) was defined as the GTV plus any microscopic extension, together with the regional lymphatics and potential sites of microscopic extension; the planning target volume (PTV) would encompass the CTV with a 3- to 5-mm margin (PTV1 for subclinical disease of nasopharynx and regional lymphatics at high risk and PTV2 for regional lymphatics at low risk). The prescribed dose to PGTV was 69.06 GY in 33 fractions, to PTV1 was 60.09 GY in 33 fractions, and to PTV2 was 50.96 GY in 28 fractions. The contoured image was transferred to a treatment planning system. The IMRT plan consisted of multileaf collimator segments of 6-MV isocentric, coplanar beams arranged in nine almost equally spaced beams. Chemotherapy was given every 3 weeks. Two cycles of neoadjuvant and 3 or 4 cycles of adjuvant chemotherapy consisting of docetaxel (75 mg/m2/day on day 1) and nedaplatin (80mg/m2/day on days 2). Results: The overall response rate to neoadjuvant chemotherapy was 84%. Three months after the completion of RT, 98% of patients achieved complete regression. With a median follow-up of 29months (range, 16e55), the 2-year locoregional failure-free survival, distant failure-free survival, progression-free survival, and overall survival were 96%, 94%, 90%, and 98%, respectively. Mucositis and weight loss were the 2 most common acute radiation-induced side effects, major grades 2w3 toxicities (36%). Leukopenia was the main adverse effect in chemotherapy; grade 4 hematological toxicity occurred occasionally during adjuvant chemotherapy. No patients had renal and electrolyte abnormalities. None of the patients had interrupted RT. The common late adverse effect was xerostomia. Conclusion: Neoadjuvanteadjuvant chemotherapy using nedaplatin and docetaxel combined with IMRT was an effective and well tolerated alternative, with outstanding compliance for locoregionally advanced NPC, but needs to be further investigated. Author Disclosure: F. Wang: None.
2731 Omission of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy: A Paired Cohort Study T. Xu,1 G. Zhu,2 C. Hu,1 and C. Shen1; 1Fudan University Shanghai Cancer Center, Shanghai, China, 2Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Purpose/Objective(s): To evaluate of the necessity of concurrent chemotherapy in T1-2N1 nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT). Materials/Methods: The retrospective analysis was conducted using the paired comparison method. We matched cases to controls using the greedy matching algorithm with 1:1 control to case ratio. Controls were matched to cases by factors including age, gender, T stage, and duration of RT. The control group included patients received IMRT alone. In the observation group, concurrent chemotherapy (DDP 40 mg/m2/w) was administrated to each paired patient additionally. Results: From January 2009 and December 2011, a total of 86 wellbalanced T1-2N1 (2002 UICC staging system) NPC patients were retrospectively analyzed. Half of them (43 patients) received radical IMRT alone and another 43 received concurrent chemotherapy with IMRT (CCRT). Median follow-up is 37.4 months (4.8e66.2 months). All patients received a radiation dose of 6 6Gy/30Fx. In the CCRT group, 44.2% patients received a cumulative dose of 200 mg/m2. The differences of 3year overall survival (OS), 3-year progression-free survival (PFS), 3-year
Volume 93 Number 3S Supplement 2015
2729 Proton Therapy for Sinonasal Mucosal Melanoma J.C. Greenwalt,1 R. Dagan,2 C.M. Bryant,3 C.G. Morris,1 and W.M. Mendenhall1; 1University of Florida, Gainesville, FL, 2 University of Florida, Jacksonville, FL, 3University of Florida Health Proton Therapy Institute, Jacksonville, FL Purpose/Objective(s): To report outcomes and toxicities in patients treated with primary or postoperative high-dose proton therapy (PT) for mucosal melanoma. Materials/Methods: We conducted an institutional review boarde approved retrospective medical record review of 7 adult patients treated for primary mucosal head and neck melanoma at our institute to determine their treatment outcomes. Seven patients with a median age of 60 years (range, 37-80) were treated with external beam PT. All 7 patients had mucosal melanoma. Primary tumor locations were the nasal cavity (nZ5), ethmoid sinus (nZ1), and maxillary sinus (nZ1). Six patients underwent gross total resection before PT and 1 patient underwent a biopsy due to unresectable disease from intracranial extension. In the postoperative setting, PT was initiated at a median of 53 days after surgery (range, 33-85). The primary target volume was defined as the surgical bed plus a margin for microscopic disease and setup uncertainties. The median PT dose to the primary high-risk planning target volume was 74.4 Gy (RBE) (range, 69.6-74.4). Six patients were treated with elective nodal radiation to the neck to a median dose of 50 Gy (range, 48-50). None of the patients had neoadjuvant, concurrent, or adjuvant chemotherapy. The outcomes evaluated were local control, distant metastasisfree survival, cause-specific survival, and overall survival. Complications were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. Results: Median follow-up was 1.4 years from the end of PT (range, 0.5 to 6.6 years). The cause-specific survival and overall survival rates were equivalent at 83% at 1 year and 67% at 1.5 years. Three patients died of metastatic disease, and all died within 25 months of completing PT. One patient who was treated with 69.6 Gy (RBE) recurred locally at 2 months after completing PT and died of distant disease. The local-regional control rate at 1 and 1.5 years were both 86% while the freedom from distant metastases rate was 71% at 1 and 1.5 years. One patient experienced grade 2 epiphora and grade 4 visual toxicity, leading to loss of useful vision in the treated eye. One patient with brain necrosis was found to have developed brain metastases requiring steroids following PT. No patient was on thyroid replacement at the time of analysis, 2 patients reported grade 2 sinusitis, 1 patient had a grade 2 oral cavity fistula, and 1 patient reported grade 2 sensorineural hearing loss. No contralateral visual complications occurred. Conclusion: PT can be utilized to escalate the dose in sinonasal mucosal melanoma while sparing uninvolved optic structures and help preserve vision. Metastatic progression remains the dominant cause of treatment failure. Our data support that postoperative RT delivered to a dose above 70 Gy (RBE) may help increase local-regional control in this disease. Author Disclosure: J.C. Greenwalt: None. R. Dagan: None. C.M. Bryant: None. C.G. Morris: None. W.M. Mendenhall: None.
2730 Experience With Combination of Nedaplatin Plus Docetaxel Chemotherapy and Intensity Modulated Radiation Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma F. Wang; Tianjin Medical University Cancer Institute and Hospital, Tianjin, China Purpose/Objective(s): The aim was to evaluate the efficacy and toxicity of nedaplatin and docetaxel chemotherapy plus intensity modulated radiation therapy (IMRT) for locoregionally advanced nasopharyngeal carcinoma (NPC).
Materials/Methods: Fifty patients diagnosed with locoregionally advanced NPC received IMRT plus neoadjuvant and adjuvant chemotherapy from February 2009 to December 2012. They were aged from 18 to 69 years; had pathologically confirmed diagnosis of WHO types II and III NPC; Stage III, IVA, and IVB. The IMRT technique was utilized for all patients. The gross target volume (GTV) included all known gross disease, and the planning GTV (PGTV) was created based on the GTV with an additional 5-mm margin. The clinical target volume (CTV) was defined as the GTV plus any microscopic extension, together with the regional lymphatics and potential sites of microscopic extension; the planning target volume (PTV) would encompass the CTV with a 3- to 5-mm margin (PTV1 for subclinical disease of nasopharynx and regional lymphatics at high risk and PTV2 for regional lymphatics at low risk). The prescribed dose to PGTV was 69.06 GY in 33 fractions, to PTV1 was 60.09 GY in 33 fractions, and to PTV2 was 50.96 GY in 28 fractions. The contoured image was transferred to a treatment planning system. The IMRT plan consisted of multileaf collimator segments of 6-MV isocentric, coplanar beams arranged in nine almost equally spaced beams. Chemotherapy was given every 3 weeks. Two cycles of neoadjuvant and 3 or 4 cycles of adjuvant chemotherapy consisting of docetaxel (75 mg/m2/day on day 1) and nedaplatin (80mg/m2/day on days 2). Results: The overall response rate to neoadjuvant chemotherapy was 84%. Three months after the completion of RT, 98% of patients achieved complete regression. With a median follow-up of 29months (range, 16e55), the 2-year locoregional failure-free survival, distant failure-free survival, progression-free survival, and overall survival were 96%, 94%, 90%, and 98%, respectively. Mucositis and weight loss were the 2 most common acute radiation-induced side effects, major grades 2w3 toxicities (36%). Leukopenia was the main adverse effect in chemotherapy; grade 4 hematological toxicity occurred occasionally during adjuvant chemotherapy. No patients had renal and electrolyte abnormalities. None of the patients had interrupted RT. The common late adverse effect was xerostomia. Conclusion: Neoadjuvanteadjuvant chemotherapy using nedaplatin and docetaxel combined with IMRT was an effective and well tolerated alternative, with outstanding compliance for locoregionally advanced NPC, but needs to be further investigated. Author Disclosure: F. Wang: None.
2731 Omission of Chemotherapy in Early-Stage Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy: A Paired Cohort Study T. Xu,1 G. Zhu,2 C. Hu,1 and C. Shen1; 1Fudan University Shanghai Cancer Center, Shanghai, China, 2Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Purpose/Objective(s): To evaluate of the necessity of concurrent chemotherapy in T1-2N1 nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiation therapy (IMRT). Materials/Methods: The retrospective analysis was conducted using the paired comparison method. We matched cases to controls using the greedy matching algorithm with 1:1 control to case ratio. Controls were matched to cases by factors including age, gender, T stage, and duration of RT. The control group included patients received IMRT alone. In the observation group, concurrent chemotherapy (DDP 40 mg/m2/w) was administrated to each paired patient additionally. Results: From January 2009 and December 2011, a total of 86 wellbalanced T1-2N1 (2002 UICC staging system) NPC patients were retrospectively analyzed. Half of them (43 patients) received radical IMRT alone and another 43 received concurrent chemotherapy with IMRT (CCRT). Median follow-up is 37.4 months (4.8e66.2 months). All patients received a radiation dose of 6 6Gy/30Fx. In the CCRT group, 44.2% patients received a cumulative dose of 200 mg/m2. The differences of 3year overall survival (OS), 3-year progression-free survival (PFS), 3-year