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Extent of Neck Dissection Predicts Survival in Oral Cavity Cancer Patients With Preoperative Node-Positive Imaging
E330
International Journal of Radiation Oncology Biology Physics
2819
in 40 fractions to bilateral nodes (1.2 Gy x 2 fractions/day). Median follow-up was 26 months (range 5-147) Results: The probability of locoregional control after radiation alone was 75.5 % at 2 years and was 56.6% at 7 years. Ten of 41 patients (24%) had locoregional failure after radiation. The median time for detection of locoregional failure was 7 months. Six of 10 patients were salvaged with surgery which was total laryngectomy and bilateral modified radical neck dissection. Therefore, the overall locoregional control rate was 90%. The risk of severe late complications was 2%.Overall survival of the entire population at 2 years was 72.2%.Most of the patients died of non-laryngeal carcinoma related causes (17/20; 85%). Conclusion: In patients with T3N0 laryngeal carcinoma, hyperfractionated RT offers favorable results without morbidity of surgery+RT or complications of concurrent chemoradiation and should be considered first with surgery reserved for salvage. Author Disclosure: B. Emami: None. M.M. Mathew: None. R.W. Borrowdale: None. R.P. Garza: None. C. Bier-Laning: None. G. Petruzzelli: None.
Extent of Neck Dissection Predicts Survival in Oral Cavity Cancer Patients With Preoperative Node-Positive Imaging J.L. Shah, T. Bui, N. Fischbein, M. Kaplan, Q.T. Le, and W. Hara; Stanford University, Stanford, CA Purpose/Objective(s): Limited recently published data have suggested that resection of at least 18 lymph nodes improves outcomes for patients treated with oral cavity cancer. Preoperative imaging is frequently used to clinically stage patients with oral cavity cancer and determine the appropriate extent of neck dissection. We sought to determine if preoperative imaging was predictive of outcomes based upon the extent of neck dissection in these patients. Materials/Methods: We retrospectively reviewed 551 consecutive patients treated at our institution from 1998 to 2013 for oral cavity squamous cell carcinoma with surgical resection followed by adjuvant therapy if indicated. Patients treated for recurrent disease and metastatic disease were not included. Of this cohort, 278 patients underwent neck dissection as a component of their initial surgical management, and 223 of these patients underwent preoperative imaging consisting of either a computed tomography (CT) Neck, positron emission tomography (PET)/ CT, or magnetic resonance imaging (MRI) Neck. For this study, we defined a select neck dissection as 0 to 19 lymph nodes, a standard dissection as 20 to 39 lymph nodes, and a comprehensive dissection as 40 or more lymph nodes. Kaplan-Meier statistics were used to describe overall survival. Results: Within the 278 patients who underwent neck dissection, 85 patients had a select dissection, 100 patients had a standard dissection, and 93 patients had a comprehensive dissection. In this cohort, there was an overall survival benefit to having a comprehensive dissection compared to a select or standard dissection (PZ.05). For the 106 patients who were node-negative by imaging, the extent of node dissection did not influence survival (PZ.29). For the 117 patients who were node-positive by imaging, there was an overall survival benefit to comprehensive dissection (PZ.0005). Node-positivity by PET-CT or MRI conferred a survival benefit with a comprehensive dissection (PZ.04, PZ.06) compared to node-positivity on CT Neck alone (PZ.64). Conclusion: Node-positivity on preoperative imaging, particularly by PETCT or MRI, may be considered an indication for a comprehensive neck dissection in patients being treated for oral cavity squamous cell carcinoma. Author Disclosure: J.L. Shah: None. T. Bui: None. N. Fischbein: None. M. Kaplan: None. Q. Le: None. W. Hara: None.
2820 Transglottic Laryngeal Carcinoma (T3 With Fixed Cords): Treatment With Radiation Therapy Alone B. Emami,1 M.M. Mathew,2 R.W. Borrowdale,3 R.P. Garza,4 C. BierLaning,3 and G. Petruzzelli5; 1Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 2Loyola University Medical Center, Maywood, IL, 3Loyola University Medical Center, Maywood, IL, 4Austin Center for Radiation Oncology, Austin, TX, 5Memorial Health Medical Center, Savannah, GA Purpose/Objective(s): Management of Transglottic squamous cell carcinoma, (T3) with fixed cords is either surgery (total laryngectomy with neck dissection) or radiation therapy (RT) +chemotherapy. With the goal of avoiding known functional and cosmetic morbidity of surgery and significant side effects of concurrent chemoradiation, we have treated those patients with hyperfractionated RT. Materials/Methods: From 1999 to 2014, 41 patients with T3N0 laryngeal tumors were treated. All patients were (1) T3 N0, (2) surgical option per tumor board was total laryngectomy+neck dissection which was discussed with the patients, and (3) treated with 3DCRT/intensity modulated RT (IMRT). Dose of XRT was 74.4 Gy in 62 fractions to the larynx and 48 Gy
2821 Influence of Magnetic Resonance Simulation on Target Volume Delineation in Local Advanced Nasopharyngeal Carcinoma Y. Sun and X. Yang; Peking University Cancer Hospital, Beijing, China Purpose/Objective(s): Currently computerized tomography (CT) is widely used in the design of treatment plan but has limitations in showing anatomical structures for nasopharyngeal carcinoma, and magnetic resonance imaging (MRI) can show accurate relationship of the tumors with their surrounding tissue structures owing to its high soft tissue resolution. This study analyzed the influence of magnetic resonance simulation (MRIsim) on target volume delineation on local advanced nasopharyngeal carcinoma (LA-NPC). Materials/Methods: The clinical data of 24 patients with LA-NPC was collected from one institution. Each patient was made scanned by computerized tomography simulation (CT-sim) and MRI-sim in the same condition on the same day. Target volumes ware delineated based on CT and MRI respectively. The data was analyzed by paired t test. Results: Gross tumor volumes (GTVs) in the target areas on CT and MRI were significantly different (PZ.001). The average volumes (cm3) of GTV-CT and GTV-MRI were 162.74 55.42 and 155.35 54.46 respectively. In the 24 cases, 19 cases were diagnosed of skull base bone invasion (SKB) in MRI and 15 cases in CT. In the SKB cases, GTVskbCT and GTVskb-MRI had significantly differences (PZ.001), and in the non-SKB cases, GTVskb-CT and GTVskb-MRI had no significantly differences (PZ.501). There were remarkable differences of target areas (cm3) of cervical lymph nodes based on CT and MRI (92.57 48.76 and 84.50 46.60, PZ.000). All of the patients were diagnosed in MRI, and 6 were not in CT. The volumes (cm3) of retropharyngeal lymph node (RPN) of GTVrpn-CT and GTVrpn-MRI were 2.03 and 2.67 respectively (PZ.028). Conclusion: Compared with CT, MRI shows a broader base of skull base bone invasion range and a higher detection rate. The general target volume based on MRI is smaller than that based on CT, which indicates that MRIbased radiation may protect the surrounding normal tissues and reduce radiation side effects. Author Disclosure: Y. Sun: None. X. Yang: None.
2822 Prognostic Value of FDG-PET for Treatment of Oral Squamous Cell Carcinoma by Retrograde Superselective Intraarterial Chemotherapy and Daily Concurrent Radiation Therapy I. Koike, M. Shimizu, K. Mitsudo, T. Inoue, and I. Tohnai; Yokohama City University, Yokohama, Japan Purpose/Objective(s): The objective of this study was to investigate whether 18fluorodeoxyglucose (FDG) uptake of primary tumor in oral
International Journal of Radiation Oncology Biology Physics
2819
in 40 fractions to bilateral nodes (1.2 Gy x 2 fractions/day). Median follow-up was 26 months (range 5-147) Results: The probability of locoregional control after radiation alone was 75.5 % at 2 years and was 56.6% at 7 years. Ten of 41 patients (24%) had locoregional failure after radiation. The median time for detection of locoregional failure was 7 months. Six of 10 patients were salvaged with surgery which was total laryngectomy and bilateral modified radical neck dissection. Therefore, the overall locoregional control rate was 90%. The risk of severe late complications was 2%.Overall survival of the entire population at 2 years was 72.2%.Most of the patients died of non-laryngeal carcinoma related causes (17/20; 85%). Conclusion: In patients with T3N0 laryngeal carcinoma, hyperfractionated RT offers favorable results without morbidity of surgery+RT or complications of concurrent chemoradiation and should be considered first with surgery reserved for salvage. Author Disclosure: B. Emami: None. M.M. Mathew: None. R.W. Borrowdale: None. R.P. Garza: None. C. Bier-Laning: None. G. Petruzzelli: None.
Extent of Neck Dissection Predicts Survival in Oral Cavity Cancer Patients With Preoperative Node-Positive Imaging J.L. Shah, T. Bui, N. Fischbein, M. Kaplan, Q.T. Le, and W. Hara; Stanford University, Stanford, CA Purpose/Objective(s): Limited recently published data have suggested that resection of at least 18 lymph nodes improves outcomes for patients treated with oral cavity cancer. Preoperative imaging is frequently used to clinically stage patients with oral cavity cancer and determine the appropriate extent of neck dissection. We sought to determine if preoperative imaging was predictive of outcomes based upon the extent of neck dissection in these patients. Materials/Methods: We retrospectively reviewed 551 consecutive patients treated at our institution from 1998 to 2013 for oral cavity squamous cell carcinoma with surgical resection followed by adjuvant therapy if indicated. Patients treated for recurrent disease and metastatic disease were not included. Of this cohort, 278 patients underwent neck dissection as a component of their initial surgical management, and 223 of these patients underwent preoperative imaging consisting of either a computed tomography (CT) Neck, positron emission tomography (PET)/ CT, or magnetic resonance imaging (MRI) Neck. For this study, we defined a select neck dissection as 0 to 19 lymph nodes, a standard dissection as 20 to 39 lymph nodes, and a comprehensive dissection as 40 or more lymph nodes. Kaplan-Meier statistics were used to describe overall survival. Results: Within the 278 patients who underwent neck dissection, 85 patients had a select dissection, 100 patients had a standard dissection, and 93 patients had a comprehensive dissection. In this cohort, there was an overall survival benefit to having a comprehensive dissection compared to a select or standard dissection (PZ.05). For the 106 patients who were node-negative by imaging, the extent of node dissection did not influence survival (PZ.29). For the 117 patients who were node-positive by imaging, there was an overall survival benefit to comprehensive dissection (PZ.0005). Node-positivity by PET-CT or MRI conferred a survival benefit with a comprehensive dissection (PZ.04, PZ.06) compared to node-positivity on CT Neck alone (PZ.64). Conclusion: Node-positivity on preoperative imaging, particularly by PETCT or MRI, may be considered an indication for a comprehensive neck dissection in patients being treated for oral cavity squamous cell carcinoma. Author Disclosure: J.L. Shah: None. T. Bui: None. N. Fischbein: None. M. Kaplan: None. Q. Le: None. W. Hara: None.
2820 Transglottic Laryngeal Carcinoma (T3 With Fixed Cords): Treatment With Radiation Therapy Alone B. Emami,1 M.M. Mathew,2 R.W. Borrowdale,3 R.P. Garza,4 C. BierLaning,3 and G. Petruzzelli5; 1Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 2Loyola University Medical Center, Maywood, IL, 3Loyola University Medical Center, Maywood, IL, 4Austin Center for Radiation Oncology, Austin, TX, 5Memorial Health Medical Center, Savannah, GA Purpose/Objective(s): Management of Transglottic squamous cell carcinoma, (T3) with fixed cords is either surgery (total laryngectomy with neck dissection) or radiation therapy (RT) +chemotherapy. With the goal of avoiding known functional and cosmetic morbidity of surgery and significant side effects of concurrent chemoradiation, we have treated those patients with hyperfractionated RT. Materials/Methods: From 1999 to 2014, 41 patients with T3N0 laryngeal tumors were treated. All patients were (1) T3 N0, (2) surgical option per tumor board was total laryngectomy+neck dissection which was discussed with the patients, and (3) treated with 3DCRT/intensity modulated RT (IMRT). Dose of XRT was 74.4 Gy in 62 fractions to the larynx and 48 Gy
2821 Influence of Magnetic Resonance Simulation on Target Volume Delineation in Local Advanced Nasopharyngeal Carcinoma Y. Sun and X. Yang; Peking University Cancer Hospital, Beijing, China Purpose/Objective(s): Currently computerized tomography (CT) is widely used in the design of treatment plan but has limitations in showing anatomical structures for nasopharyngeal carcinoma, and magnetic resonance imaging (MRI) can show accurate relationship of the tumors with their surrounding tissue structures owing to its high soft tissue resolution. This study analyzed the influence of magnetic resonance simulation (MRIsim) on target volume delineation on local advanced nasopharyngeal carcinoma (LA-NPC). Materials/Methods: The clinical data of 24 patients with LA-NPC was collected from one institution. Each patient was made scanned by computerized tomography simulation (CT-sim) and MRI-sim in the same condition on the same day. Target volumes ware delineated based on CT and MRI respectively. The data was analyzed by paired t test. Results: Gross tumor volumes (GTVs) in the target areas on CT and MRI were significantly different (PZ.001). The average volumes (cm3) of GTV-CT and GTV-MRI were 162.74 55.42 and 155.35 54.46 respectively. In the 24 cases, 19 cases were diagnosed of skull base bone invasion (SKB) in MRI and 15 cases in CT. In the SKB cases, GTVskbCT and GTVskb-MRI had significantly differences (PZ.001), and in the non-SKB cases, GTVskb-CT and GTVskb-MRI had no significantly differences (PZ.501). There were remarkable differences of target areas (cm3) of cervical lymph nodes based on CT and MRI (92.57 48.76 and 84.50 46.60, PZ.000). All of the patients were diagnosed in MRI, and 6 were not in CT. The volumes (cm3) of retropharyngeal lymph node (RPN) of GTVrpn-CT and GTVrpn-MRI were 2.03 and 2.67 respectively (PZ.028). Conclusion: Compared with CT, MRI shows a broader base of skull base bone invasion range and a higher detection rate. The general target volume based on MRI is smaller than that based on CT, which indicates that MRIbased radiation may protect the surrounding normal tissues and reduce radiation side effects. Author Disclosure: Y. Sun: None. X. Yang: None.
2822 Prognostic Value of FDG-PET for Treatment of Oral Squamous Cell Carcinoma by Retrograde Superselective Intraarterial Chemotherapy and Daily Concurrent Radiation Therapy I. Koike, M. Shimizu, K. Mitsudo, T. Inoue, and I. Tohnai; Yokohama City University, Yokohama, Japan Purpose/Objective(s): The objective of this study was to investigate whether 18fluorodeoxyglucose (FDG) uptake of primary tumor in oral