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Metastatic Undifferentiated Carcinoma in Retropharyngeal Nodes From an Unknown Primary Site: Results of Irradiation to Nasopharyngeal Mucosa Plus Bilateral Neck
E390
International Journal of Radiation Oncology Biology Physics
Author Disclosure: N. Kishi: None. Y. Imai: None. N. Kanayama: None. T. Hirata: None. Y. Kawaguchi: None. K. Konishi: None. K. Nishiyama: None. T. Teshima: None.
Purpose/Objective(s): To evaluate outcome for patients with metastatic undifferentiated carcinoma in retropharyngeal nodes who were irradiated to nasopharyngeal mucosa plus bilateral neck. Materials/Methods: From March 2004 to September 2014, patients who presented with enlarged retropharyngeal nodes underwent transoral ultrasound guiding fine-needle aspiration to confirm histology. Those with metastatic undifferentiated carcinoma with unknown primary tumor were irradiated to nasopharyngeal mucosa plus bilateral neck. Through longterm follow-ups, we evaluated endpoints including the appearance of primary tumor, overall survival and treatment-related toxicities. Results: A total of 49 patients were recruited into this study. During a follow-up time ranging from 8 months to 11 years after radiation therapy, the appearance of primary tumor in the nasopharynx was observed in 4 patients and no primary tumor outside the nasopharynx was detected for all the patients. Two patients had cervical relapse. Ten patients developed distant metastasis. Bone metastasis was found in 8 patients, lung metastasis in 4 patients and liver metastasis in 3 patients. The 5-year overall survival (OS), progression-free survival (PFS), regional relapse free survival (RFS), distant metastasis free survival (DMFS) was 79.6%, 61.1%, 83.4%, 73.8%. Nine (18%) patients experience grade 3 radiation therapy-related mucositis, and no grade 4 acute mucositis was observed. Common late adverse effects included xerostomia (57%) and hearing impairment (35%). Overall, the late effects were generally mild. Conclusion: Metastatic undifferentiated carcinoma in retropharyngeal nodes highly indicated that the primary tumor originated from the nasopharynx in NPC endemic area, and radical radiation therapy to both nasopharyngeal mucosa and bilateral neck should be recommended. Author Disclosure: C.R. Du: None. H. Ying: None. Y. Zhang: None. R. Zhai: None.
2961 Impact of Primary TumoreSpecific Growth Rate on Treatment Failure for Non-Oropharyngeal Head and Neck Cancers M.M. Fareed, T.M. Churilla, and T.J. Galloway; Fox Chase Cancer Center, Philadelphia, PA Purpose/Objective(s): To study the impact of tumor doubling time and primary tumor specific growth rate (SGR) for non-oropharyngeal head and neck cancers (Non-OPC) on treatment outcomes after definitive radiation therapy (RT). Materials/Methods: A total of 39 non-OPC patients managed with radiation (RT) or chemoradiation (CRT) with measurable primary tumor on a diagnostic scan prior to CT simulation and with no interval treatment were analyzed. Diagnostic CT scan images of all patients were imported into a commercially available contouring system and fused with the radiation treatment planning scan using deformable registration. The diagnostic tumor and nodal volumes were contoured and compared to the planning scan volumes. A tumor doubling time was calculated from these two volumes. We included 30 patients in final analysis who had a quantifiable SGR, rest of them had an SGR of 0. Overall survival (OS), progression free survival (PFS), and local recurrence (LR) were evaluated according to the Kaplan Meier method and hazard ratios were estimated using Cox Regression. We stratified patients into low versus high tumor specific growth rate according to the median tumor SGR of 1.388 per day. Results: Of 39 patients, 36 patients had laryngeal and 3 had hypopharyngeal cancers. 24 were Stage III or IV (62%). Eleven patients got RT alone and 28 (72%) were treated with CRT. Median RT dose was 70Gy (range 60-79.2). The median time between acquisition of diagnostic and simulation CT scans was 22 days (range 7-170 days). Median SGR was 0.92%/day (range 0.04-7.3). Seven patients got recurrent disease locally (18%). The average doubling time for recurrent tumors was 2.1% per day (range 0-7.3). The median follow up was 2.4 years with a median overall survival of 3.8 years. OS at median follow up was 87% for the low tumor SGR versus 64% for the high tumor SGR group (P Z 0.053). There was a trend towards increased overall mortality among patients with high tumor SGR values (HR [95% CI] Z 3.40 [0.91-12.64], P Z 0.068). Similarly, PFS at median follow up was 87% for the low tumor SGR group versus 67% for the high tumor SGR group (P Z 0.053). There was a trend towards worse PFS among patients with high tumor SGR values (HR [95% CI] Z 2.63 [0.81-8.62], P Z 0.109). However, we noted no statistically significant difference in LR rates according to tumor SGR with 7% of low tumor SGR versus 23% of high tumor SGR patients experiencing LR at the median follow up (P Z 0.441) (HR [95% CI] Z 1.99 [0.33-11.95]), P Z 0.450). Conclusion: Tumor doubling time of more than 1.388% per day correlates to significant detrimental effect on tumor control in non-OPC cancers. Although limited in power by small sample size, our analysis supports a trend towards increased overall mortality and local recurrence risk among patients with high tumor specific growth rate. Means to reduce it include shortening of time interval between diagnostic and simulation scans. Author Disclosure: M.M. Fareed: None. T.M. Churilla: None. T.J. Galloway: None.
2962 Metastatic Undifferentiated Carcinoma in Retropharyngeal Nodes From an Unknown Primary Site: Results of Irradiation to Nasopharyngeal Mucosa Plus Bilateral Neck C.R. Du,1 H. Ying,2 Y. Zhang,1 and R. Zhai1; 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 2 Fudan University Shanghai Cancer Center, Shanghai, China
2963 Outcomes and Prognostic Grouping of Human PapillomavirusePositive Oropharyngeal Squamous Cell Carcinoma Undergoing TORS/TLM and Adjuvant Radiation Therapy L. Kahn,1 D. Jackson,1 Y. Wang,2 B.A. Dyer,1 D.G. Farwell,3 A. Bewley,3 M.E. Daly,1 and S.S.D. Rao1; 1University of California Davis Comprehensive Cancer Center, Sacramento, CA, 2University of California, Davis, Davis, CA, 3University of California, Davis, Sacramento, CA Purpose/Objective(s): Outcomes for HPV-positive oropharyngeal squamous cell carcinoma (HPV+OPSCC) are superior to non-HPV related OPSCC. RTOG 0129 identified low & intermediate-risk cohorts for HPV+OPSCC following definitive chemoradiation therapy (CRT) based on smoking history & nodal stage (NS). However, it is unknown if these risk groups accurately stratify patients treated with trans-oral robotic surgery/ trans-oral laser microsurgery (TORS/TLM) & adjuvant radiation therapy (ART). We describe outcomes for HPV+OPSCC treated with TORS/TLM followed by ART/CRT and analyze features prognostic for recurrence and survival. Materials/Methods: Records of 65 consecutive patients with HPV+OPSCC treated with surgery and ART from 10/2003-11/2015 were reviewed. All patients underwent definitive resection with adjuvant intensity-modulated radiation therapy to a median dose of 66 Gy (range 6070). AJCC tumor (T) stage/NS, margin status, extracapsular extension (ECE), lymphovascular/perineural invasion (LVI, PNI), use of concurrent systemic therapy (CT), pack-years smoking (PY), and nodal ratio 10% (NR) were recorded. Influence on local-regional control (LRC), distant control (DC), and overall survival (OS) were assessed using log-rank & Cox regression methods. LRC, DC, and OS for the entire cohort and each risk category were analyzed with the Kaplan-Meier method. Results: Median age-56.6 years. Occurrence (%) of pathologic factors for the low & intermediate risk groups were: ECE (50 & 77.8), LVI (20 & 30), PNI (9.1 & 30), positive margins (12.7 & 10). Systemic therapy was used in 50.1% and 90%, respectively. Median follow-up was 39.7 months. 3 year actuarial LRC, DC, and OS for all patients were 95.5%, 85.1%, and 88.9%, respectively. Low-risk (n Z 55): LRC-94.5%, DC-84.3%, OS89.6%. Intermediate-risk (n Z 10): LRC-100%, DC-88.9%, OS-87.5%.
International Journal of Radiation Oncology Biology Physics
Author Disclosure: N. Kishi: None. Y. Imai: None. N. Kanayama: None. T. Hirata: None. Y. Kawaguchi: None. K. Konishi: None. K. Nishiyama: None. T. Teshima: None.
Purpose/Objective(s): To evaluate outcome for patients with metastatic undifferentiated carcinoma in retropharyngeal nodes who were irradiated to nasopharyngeal mucosa plus bilateral neck. Materials/Methods: From March 2004 to September 2014, patients who presented with enlarged retropharyngeal nodes underwent transoral ultrasound guiding fine-needle aspiration to confirm histology. Those with metastatic undifferentiated carcinoma with unknown primary tumor were irradiated to nasopharyngeal mucosa plus bilateral neck. Through longterm follow-ups, we evaluated endpoints including the appearance of primary tumor, overall survival and treatment-related toxicities. Results: A total of 49 patients were recruited into this study. During a follow-up time ranging from 8 months to 11 years after radiation therapy, the appearance of primary tumor in the nasopharynx was observed in 4 patients and no primary tumor outside the nasopharynx was detected for all the patients. Two patients had cervical relapse. Ten patients developed distant metastasis. Bone metastasis was found in 8 patients, lung metastasis in 4 patients and liver metastasis in 3 patients. The 5-year overall survival (OS), progression-free survival (PFS), regional relapse free survival (RFS), distant metastasis free survival (DMFS) was 79.6%, 61.1%, 83.4%, 73.8%. Nine (18%) patients experience grade 3 radiation therapy-related mucositis, and no grade 4 acute mucositis was observed. Common late adverse effects included xerostomia (57%) and hearing impairment (35%). Overall, the late effects were generally mild. Conclusion: Metastatic undifferentiated carcinoma in retropharyngeal nodes highly indicated that the primary tumor originated from the nasopharynx in NPC endemic area, and radical radiation therapy to both nasopharyngeal mucosa and bilateral neck should be recommended. Author Disclosure: C.R. Du: None. H. Ying: None. Y. Zhang: None. R. Zhai: None.
2961 Impact of Primary TumoreSpecific Growth Rate on Treatment Failure for Non-Oropharyngeal Head and Neck Cancers M.M. Fareed, T.M. Churilla, and T.J. Galloway; Fox Chase Cancer Center, Philadelphia, PA Purpose/Objective(s): To study the impact of tumor doubling time and primary tumor specific growth rate (SGR) for non-oropharyngeal head and neck cancers (Non-OPC) on treatment outcomes after definitive radiation therapy (RT). Materials/Methods: A total of 39 non-OPC patients managed with radiation (RT) or chemoradiation (CRT) with measurable primary tumor on a diagnostic scan prior to CT simulation and with no interval treatment were analyzed. Diagnostic CT scan images of all patients were imported into a commercially available contouring system and fused with the radiation treatment planning scan using deformable registration. The diagnostic tumor and nodal volumes were contoured and compared to the planning scan volumes. A tumor doubling time was calculated from these two volumes. We included 30 patients in final analysis who had a quantifiable SGR, rest of them had an SGR of 0. Overall survival (OS), progression free survival (PFS), and local recurrence (LR) were evaluated according to the Kaplan Meier method and hazard ratios were estimated using Cox Regression. We stratified patients into low versus high tumor specific growth rate according to the median tumor SGR of 1.388 per day. Results: Of 39 patients, 36 patients had laryngeal and 3 had hypopharyngeal cancers. 24 were Stage III or IV (62%). Eleven patients got RT alone and 28 (72%) were treated with CRT. Median RT dose was 70Gy (range 60-79.2). The median time between acquisition of diagnostic and simulation CT scans was 22 days (range 7-170 days). Median SGR was 0.92%/day (range 0.04-7.3). Seven patients got recurrent disease locally (18%). The average doubling time for recurrent tumors was 2.1% per day (range 0-7.3). The median follow up was 2.4 years with a median overall survival of 3.8 years. OS at median follow up was 87% for the low tumor SGR versus 64% for the high tumor SGR group (P Z 0.053). There was a trend towards increased overall mortality among patients with high tumor SGR values (HR [95% CI] Z 3.40 [0.91-12.64], P Z 0.068). Similarly, PFS at median follow up was 87% for the low tumor SGR group versus 67% for the high tumor SGR group (P Z 0.053). There was a trend towards worse PFS among patients with high tumor SGR values (HR [95% CI] Z 2.63 [0.81-8.62], P Z 0.109). However, we noted no statistically significant difference in LR rates according to tumor SGR with 7% of low tumor SGR versus 23% of high tumor SGR patients experiencing LR at the median follow up (P Z 0.441) (HR [95% CI] Z 1.99 [0.33-11.95]), P Z 0.450). Conclusion: Tumor doubling time of more than 1.388% per day correlates to significant detrimental effect on tumor control in non-OPC cancers. Although limited in power by small sample size, our analysis supports a trend towards increased overall mortality and local recurrence risk among patients with high tumor specific growth rate. Means to reduce it include shortening of time interval between diagnostic and simulation scans. Author Disclosure: M.M. Fareed: None. T.M. Churilla: None. T.J. Galloway: None.
2962 Metastatic Undifferentiated Carcinoma in Retropharyngeal Nodes From an Unknown Primary Site: Results of Irradiation to Nasopharyngeal Mucosa Plus Bilateral Neck C.R. Du,1 H. Ying,2 Y. Zhang,1 and R. Zhai1; 1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 2 Fudan University Shanghai Cancer Center, Shanghai, China
2963 Outcomes and Prognostic Grouping of Human PapillomavirusePositive Oropharyngeal Squamous Cell Carcinoma Undergoing TORS/TLM and Adjuvant Radiation Therapy L. Kahn,1 D. Jackson,1 Y. Wang,2 B.A. Dyer,1 D.G. Farwell,3 A. Bewley,3 M.E. Daly,1 and S.S.D. Rao1; 1University of California Davis Comprehensive Cancer Center, Sacramento, CA, 2University of California, Davis, Davis, CA, 3University of California, Davis, Sacramento, CA Purpose/Objective(s): Outcomes for HPV-positive oropharyngeal squamous cell carcinoma (HPV+OPSCC) are superior to non-HPV related OPSCC. RTOG 0129 identified low & intermediate-risk cohorts for HPV+OPSCC following definitive chemoradiation therapy (CRT) based on smoking history & nodal stage (NS). However, it is unknown if these risk groups accurately stratify patients treated with trans-oral robotic surgery/ trans-oral laser microsurgery (TORS/TLM) & adjuvant radiation therapy (ART). We describe outcomes for HPV+OPSCC treated with TORS/TLM followed by ART/CRT and analyze features prognostic for recurrence and survival. Materials/Methods: Records of 65 consecutive patients with HPV+OPSCC treated with surgery and ART from 10/2003-11/2015 were reviewed. All patients underwent definitive resection with adjuvant intensity-modulated radiation therapy to a median dose of 66 Gy (range 6070). AJCC tumor (T) stage/NS, margin status, extracapsular extension (ECE), lymphovascular/perineural invasion (LVI, PNI), use of concurrent systemic therapy (CT), pack-years smoking (PY), and nodal ratio 10% (NR) were recorded. Influence on local-regional control (LRC), distant control (DC), and overall survival (OS) were assessed using log-rank & Cox regression methods. LRC, DC, and OS for the entire cohort and each risk category were analyzed with the Kaplan-Meier method. Results: Median age-56.6 years. Occurrence (%) of pathologic factors for the low & intermediate risk groups were: ECE (50 & 77.8), LVI (20 & 30), PNI (9.1 & 30), positive margins (12.7 & 10). Systemic therapy was used in 50.1% and 90%, respectively. Median follow-up was 39.7 months. 3 year actuarial LRC, DC, and OS for all patients were 95.5%, 85.1%, and 88.9%, respectively. Low-risk (n Z 55): LRC-94.5%, DC-84.3%, OS89.6%. Intermediate-risk (n Z 10): LRC-100%, DC-88.9%, OS-87.5%.