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Intensity Modulated Proton (IMPT) Versus Photon (IMRT) Radiation Therapies: Comparing Patient-Reported Outcomes (PRO) in Patients With Oropharyngeal Cancer Undergoing Chemoradiation
958
International Journal of Radiation Oncology Biology Physics
326
Research; the University of Texas MD Anderson Cancer Center, Houston, TX, 3The University of Texas MD Anderson Cancer Center, Houston, TX, 4 GUSTAVE ROUSSY INSTITUTE, Villejuif, France, 5MD Anderson Cancer Center, Houston, TX, 6Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation therapy for Oropharyngeal Cancer (OPC) A. Kanwar,1 A.J. Hayes,2 A.S.R. Mohamed,3 C.C. French,4 G.B. Gunn,3 B.M. Beadle,3 J. Phan,3 H.D. Skinner,3 S. Lai,3 M.S. Kies,3 R.S. Weber,3 W.H. Morrison,3 D.I. Rosenthal,3 C.D. Fuller,3 and A.S. Garden3; 1Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 2 University of North Texas Health Science Center, Fort Worth, TX, 3The University of Texas MD Anderson Cancer Center, Houston, TX, 4The University of Texas Medical School at Houston, Houston, TX Purpose/Objective(s): To assess the prognostic value and utility of pretreatment systemic inflammatory markers, namely neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), in risk stratification of patients receiving definitive radiation therapy (RT) for OPC. Materials/Methods: We identified patients from an institutional review boardeapproved institutional database of OPC outcome data who had preRT WBC and platelet counts collected within 6 weeks prior to initiation of RT. NLR and PLR were calculated by dividing absolute neutrophil and platelet counts by absolute lymphocyte counts, respectively. Recursive partitioning analysis (RPA) was performed to find specific cut points associated with mortality in NLR and PLR. Kaplan-Meier and log-rank tests were used to evaluate overall survival (OS) in identified cohorts. Univariate and multivariate analyses were conducted using the following variables: age, smoking, T and N stage, sex, chemotherapy, and pre-RT NLR and PLR; the Cox proportional hazards model was used to identify a relationship between OS and pre-RT NLR and PLR. Results: A total of 448 patients were analyzed with a median follow-up of 87 months. Of these patients, 89% were men with a median age of 56 years. The majority had stage IVa disease (64%). Two hundred eighty-two patients (63%) were treated using concurrent chemoRT, and 166 (37%) received RT alone. RPA yielded an NLR cut point of 4.3 and a PLR cut point of 183. Univariate analysis at these thresholds showed a statistically significant association between NLR 4.3 and mortality (hazard ratio [HR] 2.215; 95% confidence interval [CI] 1.57-3.13, P<.0001). A similar association between PLR 183 and death was encountered (HR 2.27; 95% CI 1.60-3.26, P<.0001). The 5-year OS was significantly better for patients with NLR <4.3 (nZ276) compared to those with NLR 4.3 (84% vs 66%, P<.0001). Likewise, patients with PLR <183 (nZ235) had better 5-year OS compared to those with PLR 183 (85% vs 69%, P<.0001). Patients with elevations of both NLR and PLR beyond the identified cut points fared the worst compared to those without either (87% vs 66%, P<.0001). In multivariate analysis, both NLR and PLR proved to be independent prognostic factors for OS; NLR 4.3 (HR 1.55; 95% CI 1.06-2.27, PZ.023) and PLR 183 (HR 1.89; 95%CI 1.28-2.85, PZ.0012). Conclusion: Pretreatment systemic inflammatory markers are independent prognostic factors for survival in OPC patients treated with RT. Future investigations to validate the identified cut points and to develop riskadaptive treatment strategies are needed. Author Disclosure: A. Kanwar: None. A.J. Hayes: None. A.S. Mohamed: None. C.C. French: None. G.B. Gunn: None. B.M. Beadle: None. J. Phan: None. H.D. Skinner: None. S. Lai: None. M.S. Kies: None. R.S. Weber: None. W.H. Morrison: None. D.I. Rosenthal: None. C.D. Fuller: Research Grant; National Institutes of Health/National Cancer Institute, SWOG/Hope Foundation, Elekta AB/MD Anderson, MD Anderson Cancer Center. In-kind Donation; General Electric Healthcare/MD Anderson. A.S. Garden: None.
327 Intensity Modulated Proton (IMPT) Versus Photon (IMRT) Radiation Therapies: Comparing Patient-Reported Outcomes (PRO) in Patients With Oropharyngeal Cancer Undergoing Chemoradiation T.T.W. Sio,1 H.K. Lin,2 Q. Shi,2 G.B. Gunn,3 C.S. Cleeland,3 P. Blanchard,4 N.G. Thaker,5 J. Phan,3 D.I. Rosenthal,3 A.S. Garden,3 W.H. Morrison,3 C.D. Fuller,3 T.R. Mendoza,3 X.S. Wang,6 and S.J. Frank3; 1Mayo Clinic, Scottsdale, AZ, 2Department of Symptom
Purpose/Objective(s): Treatments with IMPT for oropharyngeal cancer are becoming increasingly common and may translate into producing better patient (pt)-reported outcome (PRO) due to its superior physical beam properties sparing organ at-risk structures, as compared with photon-based IMRT. We hypothesized that pts treated with proton radiation therapy (RT) would have less symptom burden as measured by PRO surveys. Materials/Methods: From 2006 to 2013, through prospective registries, pts with oropharyngeal cancer treated definitively with either concurrent chemoIMPT or chemo-IMRT completed the 22-item MD Anderson Symptom Inventory-Head and Neck Cancer (MDASI-HN) symptom module at various time intervals, including baseline, weekly during treatments (acute phase), 0 to 3 months after RT completion (subacute phase), and at scheduled follow-ups thereafter (chronic phase, up to 24 months). Each individual item in the MDASI-HN is scored from 0 to 10 (10 being worst). Individual and top 5 and 11 of most affected symptoms were calculated and retrospectively compared by descriptive and Student t test analyses. Results: PRO data from 35 and 46 consecutive pts from the proton and photon groups were collected and analyzed, respectively. The overall top 5 symptoms were food taste (mean 4.91), dry mouth (4.49), swallowing difficulties (4.26), lack of appetite (4.08), and fatigue (4.00). These top 5 symptoms averaged 3.892.96 for IMPT versus 4.662.98 for IMRT (PZ.04). The remaining symptoms included in the top 11 symptom cluster were (in descending order) mucus production, pain, disturbed sleep, drowsiness/sleepiness, mouth/throat sores, and distress/upset. By overall scoring, the individual scores of mucus production (mean, 3.37 vs 4.21), lack of appetite (3.43 vs 4.52), nausea (1.40 vs 2.14), vomiting (0.66 vs 1.22), and shortness of breath (0.59 vs 0.99) all favored proton therapy (P<.05); none of the remaining individual items statistically favored IMPT or IMRT. The respective top 11 scores were 3.502.74 versus 3.992.60 (PZ.14). By phases, the comparative PRO results for the top 5 symptoms were summarized (see Table 1), with a statistically significant difference favoring IMPT in the subacute phase. Conclusion: Our PRO results demonstrated less symptom burden in pts treated with IMPT in the top 5 symptoms cumulatively, as well as 5 individual symptom items. The greatest decrease in symptom burden was seen with IMPT during the subacute phase, which represents a crucial period of pts’ experience with some of the greatest symptom burden. The use of proton therapy for oropharyngeal cancer is encouraging, and we are currently validating this in a prospective clinical trial. Author Disclosure: T.T. Sio: None. H. Lin: None. Q. Shi: None. G.B. Gunn: None. C.S. Cleeland: None. P. Blanchard: None. N.G. Thaker: None. J. Phan: None. D.I. Rosenthal: None. A.S. Garden: None. W.H. Morrison: None. C.D. Fuller: None. T.R. Mendoza: None. X.S. Wang: None. S.J. Frank: None.
Abstract 327; Table 1
Baseline Acute Subacute Chronic
Proton-IMPT
IMRT
Mean (SD) (nZ35)
Mean (SD) (nZ46)
1.11 5.97 5.15 3.66
(1.32) (2.53) (2.66) (2.15)
1.41 6.44 6.58 4.14
(2.15) (1.98) (1.98) (1.90)
P value .48 .36 .01 .43
328 Comparison of Head and Neck Cancer Populations by Cause of Death S. Massa,1 N. Osazuwa-Peters,1 K. Christopher,1 R. Walker,2 and M. Varvares3; 1Saint Louis University School of Medicine, Saint Louis, MO, 2Saint Louis University School of Medicine, St Louis, MO, 3Harvard Medical School, Boston, MA
International Journal of Radiation Oncology Biology Physics
326
Research; the University of Texas MD Anderson Cancer Center, Houston, TX, 3The University of Texas MD Anderson Cancer Center, Houston, TX, 4 GUSTAVE ROUSSY INSTITUTE, Villejuif, France, 5MD Anderson Cancer Center, Houston, TX, 6Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation therapy for Oropharyngeal Cancer (OPC) A. Kanwar,1 A.J. Hayes,2 A.S.R. Mohamed,3 C.C. French,4 G.B. Gunn,3 B.M. Beadle,3 J. Phan,3 H.D. Skinner,3 S. Lai,3 M.S. Kies,3 R.S. Weber,3 W.H. Morrison,3 D.I. Rosenthal,3 C.D. Fuller,3 and A.S. Garden3; 1Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, 2 University of North Texas Health Science Center, Fort Worth, TX, 3The University of Texas MD Anderson Cancer Center, Houston, TX, 4The University of Texas Medical School at Houston, Houston, TX Purpose/Objective(s): To assess the prognostic value and utility of pretreatment systemic inflammatory markers, namely neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), in risk stratification of patients receiving definitive radiation therapy (RT) for OPC. Materials/Methods: We identified patients from an institutional review boardeapproved institutional database of OPC outcome data who had preRT WBC and platelet counts collected within 6 weeks prior to initiation of RT. NLR and PLR were calculated by dividing absolute neutrophil and platelet counts by absolute lymphocyte counts, respectively. Recursive partitioning analysis (RPA) was performed to find specific cut points associated with mortality in NLR and PLR. Kaplan-Meier and log-rank tests were used to evaluate overall survival (OS) in identified cohorts. Univariate and multivariate analyses were conducted using the following variables: age, smoking, T and N stage, sex, chemotherapy, and pre-RT NLR and PLR; the Cox proportional hazards model was used to identify a relationship between OS and pre-RT NLR and PLR. Results: A total of 448 patients were analyzed with a median follow-up of 87 months. Of these patients, 89% were men with a median age of 56 years. The majority had stage IVa disease (64%). Two hundred eighty-two patients (63%) were treated using concurrent chemoRT, and 166 (37%) received RT alone. RPA yielded an NLR cut point of 4.3 and a PLR cut point of 183. Univariate analysis at these thresholds showed a statistically significant association between NLR 4.3 and mortality (hazard ratio [HR] 2.215; 95% confidence interval [CI] 1.57-3.13, P<.0001). A similar association between PLR 183 and death was encountered (HR 2.27; 95% CI 1.60-3.26, P<.0001). The 5-year OS was significantly better for patients with NLR <4.3 (nZ276) compared to those with NLR 4.3 (84% vs 66%, P<.0001). Likewise, patients with PLR <183 (nZ235) had better 5-year OS compared to those with PLR 183 (85% vs 69%, P<.0001). Patients with elevations of both NLR and PLR beyond the identified cut points fared the worst compared to those without either (87% vs 66%, P<.0001). In multivariate analysis, both NLR and PLR proved to be independent prognostic factors for OS; NLR 4.3 (HR 1.55; 95% CI 1.06-2.27, PZ.023) and PLR 183 (HR 1.89; 95%CI 1.28-2.85, PZ.0012). Conclusion: Pretreatment systemic inflammatory markers are independent prognostic factors for survival in OPC patients treated with RT. Future investigations to validate the identified cut points and to develop riskadaptive treatment strategies are needed. Author Disclosure: A. Kanwar: None. A.J. Hayes: None. A.S. Mohamed: None. C.C. French: None. G.B. Gunn: None. B.M. Beadle: None. J. Phan: None. H.D. Skinner: None. S. Lai: None. M.S. Kies: None. R.S. Weber: None. W.H. Morrison: None. D.I. Rosenthal: None. C.D. Fuller: Research Grant; National Institutes of Health/National Cancer Institute, SWOG/Hope Foundation, Elekta AB/MD Anderson, MD Anderson Cancer Center. In-kind Donation; General Electric Healthcare/MD Anderson. A.S. Garden: None.
327 Intensity Modulated Proton (IMPT) Versus Photon (IMRT) Radiation Therapies: Comparing Patient-Reported Outcomes (PRO) in Patients With Oropharyngeal Cancer Undergoing Chemoradiation T.T.W. Sio,1 H.K. Lin,2 Q. Shi,2 G.B. Gunn,3 C.S. Cleeland,3 P. Blanchard,4 N.G. Thaker,5 J. Phan,3 D.I. Rosenthal,3 A.S. Garden,3 W.H. Morrison,3 C.D. Fuller,3 T.R. Mendoza,3 X.S. Wang,6 and S.J. Frank3; 1Mayo Clinic, Scottsdale, AZ, 2Department of Symptom
Purpose/Objective(s): Treatments with IMPT for oropharyngeal cancer are becoming increasingly common and may translate into producing better patient (pt)-reported outcome (PRO) due to its superior physical beam properties sparing organ at-risk structures, as compared with photon-based IMRT. We hypothesized that pts treated with proton radiation therapy (RT) would have less symptom burden as measured by PRO surveys. Materials/Methods: From 2006 to 2013, through prospective registries, pts with oropharyngeal cancer treated definitively with either concurrent chemoIMPT or chemo-IMRT completed the 22-item MD Anderson Symptom Inventory-Head and Neck Cancer (MDASI-HN) symptom module at various time intervals, including baseline, weekly during treatments (acute phase), 0 to 3 months after RT completion (subacute phase), and at scheduled follow-ups thereafter (chronic phase, up to 24 months). Each individual item in the MDASI-HN is scored from 0 to 10 (10 being worst). Individual and top 5 and 11 of most affected symptoms were calculated and retrospectively compared by descriptive and Student t test analyses. Results: PRO data from 35 and 46 consecutive pts from the proton and photon groups were collected and analyzed, respectively. The overall top 5 symptoms were food taste (mean 4.91), dry mouth (4.49), swallowing difficulties (4.26), lack of appetite (4.08), and fatigue (4.00). These top 5 symptoms averaged 3.892.96 for IMPT versus 4.662.98 for IMRT (PZ.04). The remaining symptoms included in the top 11 symptom cluster were (in descending order) mucus production, pain, disturbed sleep, drowsiness/sleepiness, mouth/throat sores, and distress/upset. By overall scoring, the individual scores of mucus production (mean, 3.37 vs 4.21), lack of appetite (3.43 vs 4.52), nausea (1.40 vs 2.14), vomiting (0.66 vs 1.22), and shortness of breath (0.59 vs 0.99) all favored proton therapy (P<.05); none of the remaining individual items statistically favored IMPT or IMRT. The respective top 11 scores were 3.502.74 versus 3.992.60 (PZ.14). By phases, the comparative PRO results for the top 5 symptoms were summarized (see Table 1), with a statistically significant difference favoring IMPT in the subacute phase. Conclusion: Our PRO results demonstrated less symptom burden in pts treated with IMPT in the top 5 symptoms cumulatively, as well as 5 individual symptom items. The greatest decrease in symptom burden was seen with IMPT during the subacute phase, which represents a crucial period of pts’ experience with some of the greatest symptom burden. The use of proton therapy for oropharyngeal cancer is encouraging, and we are currently validating this in a prospective clinical trial. Author Disclosure: T.T. Sio: None. H. Lin: None. Q. Shi: None. G.B. Gunn: None. C.S. Cleeland: None. P. Blanchard: None. N.G. Thaker: None. J. Phan: None. D.I. Rosenthal: None. A.S. Garden: None. W.H. Morrison: None. C.D. Fuller: None. T.R. Mendoza: None. X.S. Wang: None. S.J. Frank: None.
Abstract 327; Table 1
Baseline Acute Subacute Chronic
Proton-IMPT
IMRT
Mean (SD) (nZ35)
Mean (SD) (nZ46)
1.11 5.97 5.15 3.66
(1.32) (2.53) (2.66) (2.15)
1.41 6.44 6.58 4.14
(2.15) (1.98) (1.98) (1.90)
P value .48 .36 .01 .43
328 Comparison of Head and Neck Cancer Populations by Cause of Death S. Massa,1 N. Osazuwa-Peters,1 K. Christopher,1 R. Walker,2 and M. Varvares3; 1Saint Louis University School of Medicine, Saint Louis, MO, 2Saint Louis University School of Medicine, St Louis, MO, 3Harvard Medical School, Boston, MA