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Improved Survival following Surgery and Radiation for Olfactory Neuroblastoma: Analysis of the SEER Database
I. J. Radiation Oncology d Biology d Physics
S396
Volume 75, Number 3, Supplement, 2009
disease and 27 (64.3%) patients had N1 disease. The dose to gross tumor volume ranged from 68–72 Gy in 34 fractions. Median follow-up was 74 months after completion of IMRT. The 5 years local control rates were 93.8% and 92.9%, respectively, for patients with T1 and T2 disease, neck node control rate were 96.9% and 92.9%, distant metastases rates were 0% and 20.6%, relapsefree survival was 90.6% and 74.9%, and overall survival was 100% and 80.6%, respectively. Local control and neck node control were not affected by T-Stage (p = 0.72 and 0.45, respectively). However, distant metastases rate was significantly higher among patients with T2b disease (p = 0.007) and contributed to poorer 5 years overall survival (p = 0.01). The distant metastases rates of patients with N0 (n = 42) and N1 (n = 33) disease were 4.9% and 18.8%, respectively (p = 0.07). In multivariate analysis testing age, gender, T-Stage and N-Stage, only T-Stage was found to be significant prognostic factor for distant metastases. Conclusions: With use of IMRT, parapharyngeal extension of NPC is no longer significant for local control but is still important prognostic factor for distant metastases. Parapharyngeal boost is no longer indicated after IMRT but chemotherapy in addition to IMRT should be considered to reduce distant failure. Author Disclosure: D. Kwong, None; J. Sham, None; G. Au, None.
2478
Improved Survival following Surgery and Radiation for Olfactory Neuroblastoma: Analysis of the SEER Database
M. E. Platek, T. L. Mashtare, S. R. Popat, M. Merzianu, A. K. Singh Roswell Park Cancer Institute, Buffalo, NY Purpose/Objective(s): Olfactory neuroblastoma (also known as esthesioneuroblastoma) is an uncommon malignant nasal tumor and current knowledge of the outcomes of management strategies is based on very small single institution reviews. This analysis sought to identify a larger cohort of patients and report outcomes of commonly applied treatment strategies. Materials/Methods: The Surveillance, Epidemiology, and End Results (SEER) database for the years 1973 to 2005 was used to examine management strategies for olfactory neuroblastoma (diagnosis code 9522/3). Treatment methods relating to chemotherapy were not available. Surgical and radiation treatment methods were summarized using frequencies and cumulative frequencies. Kaplan-Meier methods were used to estimate survival distributions. Statistical assessment of observed differences in survival distributions was done using the log–rank test in conjunction with a Bonferroni adjustment for multiple comparisons. A 0.05 nominal significance level was used in all hypothesis testing. Data analyses were performed using SAS, version 9.1.3, statistical software (SAS Institute., Cary, NC). Results: A total of 135 cases were reported for this time period. The majority of cases received both surgery and radiation (59%). Approximately 23% received surgery only, 12% received radiation only and 6% received neither surgery nor radiation. There was a significant difference in the overall survival between these four treatment groups (p = 0.02). The percentage of cases surviving five years by treatment modality was: 66% for surgery with radiation, 51% for surgery only, 26% for radiation only, and 34% for neither surgery nor radiation. Pair-wise comparisons showed a significant difference in the overall survival distributions between patients who received both surgery and radiation and patients who received radiation only (p = 0.03). All other comparisons were not significantly different. Conclusions: Best survival results following treatment for olfactory neuroblastoma in this series were obtained with surgery and radiation (5 year survival = 66%.) Data for use of chemotherapy were not available. Author Disclosure: M.E. Platek, None; T.L. Mashtare, None; S.R. Popat, None; M. Merzianu, None; A.K. Singh, None.
2479
Chronic Dysphagia after IMRT/Chemotherapy is Associated with Higher Mean Pharyngeal Constrictor Dose
A. M. Farach1, C. E. Champ1, I. Buzurovic1, A. S. Harrison1, W. M. Keane2, M. Machtay1 1 Department of Radiation Oncology, Jefferson Medical College and the Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 2Department of Otorhinolaryngology-Head and Neck Surgery, Jefferson Medical College and the Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
Purpose/Objective(s): There is limited information correlating the relationship between pharyngeal constrictor dose-volume-histogram (DVH) data and chronic post-(chemo) IMRT toxicity. We investigated our institutional experience in a series of patients treated with aggressive combined modality therapy. Materials/Methods: Patients from 2006–2008 with Stage III–IV cancer of the larynx/hypopharynx and/or bulky (crossing-midline) oropharynx tumors (i.e., excluding well-lateralized tonsil cancers) were analyzed. All patients received step-and-shoot, comprehensive head and neck IMRT plus concurrent cisplatin-based chemotherapy and/or cetuximab. DVHs of the pharyngeal constrictors (contoured as one structure encompassing superior/middle/inferior muscles) were analyzed, with particular attention to the mean dose. Chronic dysphagia was defined as physician-scored Grade 2 or greater toxicity (CTCv3 criteria) more than 270 days following the completion of IMRT. We also analyzed patient-reported outcomes (FACT-HN module) 1 year following IMRT. Results: 39 patients were analyzed. Median age was 58 (range, 40–82); most patients had oropharynx cancer (n = 18), while 10 patients had larynx cancer and 3 patients had pyriform sinus cancer. At a median follow-up of 15 months, actuarial 18-months disease free survival is 71%. Eight patients were inevaluable for chronic toxicity/functional outcome due to local-regional failure (n = 4) and/or early death (n = 4). Of the evaluable patients, 10 had chronic Grade 2–3 dysphagia (32%). The median value of the mean pharyngeal-constrictor dose in this patient population was 56.6 Gy. Using this as the cutoff, there were 2/15 patients (13%) with chronic dysphagia at doses below the median, compared with 8/16 (50%) with chronic dysphagia at mean constrictor doses above 56.6 Gy (p = 0.03). There were four patients with mean constrictor dose . 64 Gy; all of these patients had chronic dysphagia. Median duration of PEG tube usage was 174 days among patients with lower constrictor doses, compared with 252 days among patients with constrictor dose . 56.6 Gy (p = 0.04 by 1-sided t test). Despite the differences in objective measures, there were no clinically or statistically significant differences in FACT-HN scores. Conclusions: Chronic dysphagia and duration of PEG tube nutritional supplementation after IMRT/chemotherapy are significantly increased as a function of the mean dose to the pharyngeal constrictors. However, within the limitations of this study, we could not identify an association between dose and patient-reported outcomes. Author Disclosure: A.M. Farach, None; C.E. Champ, None; I. Buzurovic, None; A.S. Harrison, None; W.M. Keane, None; M. Machtay, None.
S396
Volume 75, Number 3, Supplement, 2009
disease and 27 (64.3%) patients had N1 disease. The dose to gross tumor volume ranged from 68–72 Gy in 34 fractions. Median follow-up was 74 months after completion of IMRT. The 5 years local control rates were 93.8% and 92.9%, respectively, for patients with T1 and T2 disease, neck node control rate were 96.9% and 92.9%, distant metastases rates were 0% and 20.6%, relapsefree survival was 90.6% and 74.9%, and overall survival was 100% and 80.6%, respectively. Local control and neck node control were not affected by T-Stage (p = 0.72 and 0.45, respectively). However, distant metastases rate was significantly higher among patients with T2b disease (p = 0.007) and contributed to poorer 5 years overall survival (p = 0.01). The distant metastases rates of patients with N0 (n = 42) and N1 (n = 33) disease were 4.9% and 18.8%, respectively (p = 0.07). In multivariate analysis testing age, gender, T-Stage and N-Stage, only T-Stage was found to be significant prognostic factor for distant metastases. Conclusions: With use of IMRT, parapharyngeal extension of NPC is no longer significant for local control but is still important prognostic factor for distant metastases. Parapharyngeal boost is no longer indicated after IMRT but chemotherapy in addition to IMRT should be considered to reduce distant failure. Author Disclosure: D. Kwong, None; J. Sham, None; G. Au, None.
2478
Improved Survival following Surgery and Radiation for Olfactory Neuroblastoma: Analysis of the SEER Database
M. E. Platek, T. L. Mashtare, S. R. Popat, M. Merzianu, A. K. Singh Roswell Park Cancer Institute, Buffalo, NY Purpose/Objective(s): Olfactory neuroblastoma (also known as esthesioneuroblastoma) is an uncommon malignant nasal tumor and current knowledge of the outcomes of management strategies is based on very small single institution reviews. This analysis sought to identify a larger cohort of patients and report outcomes of commonly applied treatment strategies. Materials/Methods: The Surveillance, Epidemiology, and End Results (SEER) database for the years 1973 to 2005 was used to examine management strategies for olfactory neuroblastoma (diagnosis code 9522/3). Treatment methods relating to chemotherapy were not available. Surgical and radiation treatment methods were summarized using frequencies and cumulative frequencies. Kaplan-Meier methods were used to estimate survival distributions. Statistical assessment of observed differences in survival distributions was done using the log–rank test in conjunction with a Bonferroni adjustment for multiple comparisons. A 0.05 nominal significance level was used in all hypothesis testing. Data analyses were performed using SAS, version 9.1.3, statistical software (SAS Institute., Cary, NC). Results: A total of 135 cases were reported for this time period. The majority of cases received both surgery and radiation (59%). Approximately 23% received surgery only, 12% received radiation only and 6% received neither surgery nor radiation. There was a significant difference in the overall survival between these four treatment groups (p = 0.02). The percentage of cases surviving five years by treatment modality was: 66% for surgery with radiation, 51% for surgery only, 26% for radiation only, and 34% for neither surgery nor radiation. Pair-wise comparisons showed a significant difference in the overall survival distributions between patients who received both surgery and radiation and patients who received radiation only (p = 0.03). All other comparisons were not significantly different. Conclusions: Best survival results following treatment for olfactory neuroblastoma in this series were obtained with surgery and radiation (5 year survival = 66%.) Data for use of chemotherapy were not available. Author Disclosure: M.E. Platek, None; T.L. Mashtare, None; S.R. Popat, None; M. Merzianu, None; A.K. Singh, None.
2479
Chronic Dysphagia after IMRT/Chemotherapy is Associated with Higher Mean Pharyngeal Constrictor Dose
A. M. Farach1, C. E. Champ1, I. Buzurovic1, A. S. Harrison1, W. M. Keane2, M. Machtay1 1 Department of Radiation Oncology, Jefferson Medical College and the Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, 2Department of Otorhinolaryngology-Head and Neck Surgery, Jefferson Medical College and the Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
Purpose/Objective(s): There is limited information correlating the relationship between pharyngeal constrictor dose-volume-histogram (DVH) data and chronic post-(chemo) IMRT toxicity. We investigated our institutional experience in a series of patients treated with aggressive combined modality therapy. Materials/Methods: Patients from 2006–2008 with Stage III–IV cancer of the larynx/hypopharynx and/or bulky (crossing-midline) oropharynx tumors (i.e., excluding well-lateralized tonsil cancers) were analyzed. All patients received step-and-shoot, comprehensive head and neck IMRT plus concurrent cisplatin-based chemotherapy and/or cetuximab. DVHs of the pharyngeal constrictors (contoured as one structure encompassing superior/middle/inferior muscles) were analyzed, with particular attention to the mean dose. Chronic dysphagia was defined as physician-scored Grade 2 or greater toxicity (CTCv3 criteria) more than 270 days following the completion of IMRT. We also analyzed patient-reported outcomes (FACT-HN module) 1 year following IMRT. Results: 39 patients were analyzed. Median age was 58 (range, 40–82); most patients had oropharynx cancer (n = 18), while 10 patients had larynx cancer and 3 patients had pyriform sinus cancer. At a median follow-up of 15 months, actuarial 18-months disease free survival is 71%. Eight patients were inevaluable for chronic toxicity/functional outcome due to local-regional failure (n = 4) and/or early death (n = 4). Of the evaluable patients, 10 had chronic Grade 2–3 dysphagia (32%). The median value of the mean pharyngeal-constrictor dose in this patient population was 56.6 Gy. Using this as the cutoff, there were 2/15 patients (13%) with chronic dysphagia at doses below the median, compared with 8/16 (50%) with chronic dysphagia at mean constrictor doses above 56.6 Gy (p = 0.03). There were four patients with mean constrictor dose . 64 Gy; all of these patients had chronic dysphagia. Median duration of PEG tube usage was 174 days among patients with lower constrictor doses, compared with 252 days among patients with constrictor dose . 56.6 Gy (p = 0.04 by 1-sided t test). Despite the differences in objective measures, there were no clinically or statistically significant differences in FACT-HN scores. Conclusions: Chronic dysphagia and duration of PEG tube nutritional supplementation after IMRT/chemotherapy are significantly increased as a function of the mean dose to the pharyngeal constrictors. However, within the limitations of this study, we could not identify an association between dose and patient-reported outcomes. Author Disclosure: A.M. Farach, None; C.E. Champ, None; I. Buzurovic, None; A.S. Harrison, None; W.M. Keane, None; M. Machtay, None.