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concomitant boost radiation with or without daily subcutaneous amifostine in patients with newly diagnosed locally advanced head and neck cancer
treatment occurred in 128 (85%) with 94 (63%) having no local recurrence. Nodal recurrence occurred in 29 (19%). Salvage treatment was performed in 38 patients with only nine local and seven nodal recurrences being ultimately salvaged, for an ultimate local control rate of 70%. Death was less likely to be related to FOM carcinoma. Conclusion: In this study local failure occurred in 41 out of 150 patients providing strong impetus to improve the outcome for these patients, although death from other causes is still more likely. doi:10.1016/j.oos.2009.06.111
O27. The role of induction chemotherapy on survival of locally advanced oral cavity cancer K.H. Kim *, I.J. Choi, S.Y. An, J.H. Hah, T.K. Kwon, M.W. Sung Department of Otorhinolaryngology, Seoul National University College of Medicine, Republic of Korea Introduction: This study was conducted to determine the role of induction chemotherapy on survival in locally advanced (T3, 4) oral cancer. Methods: A retrospective analysis was performed on 89 eligible patients with stages III–IV American Joint Committee on Cancer (AJCC 2007) staging system squamous cell carcinoma of the oral cavity at the study department between 1987 and 2006. These patients received one of three treatments: Induction chemotherapy followed by surgery or RT (Group A, n = 38), Surgery or RT or Surgery with RT (Group B, n = 44) Concomitant chemoradiotherapy (Group C, n = 7). Induction chemotherapy mainly comprised two cycles of cisplatin/ 5-fluorouracil (FP). Results: When all 89 patients were analyzed, Group B (2-year overall survival rate: 69% disease free survival rate: 71%) showed significantly higher survival rates than Group A (2-year survival rate: 45% disease free survival rate 36%) and Group C (2-year survival rate: 33% disease free survival rate 33%). Within 48 patients with T3, T4 stage disease, there was no significant difference in overall survival and disease free survival between each group. Among 19 patients who underwent induction chemotherapy, organ preservation was successful in 15 (78.4%) patients. However, wide resection and free flap reconstruction was mandatory for all (14/14) patients who received surgical treatment. Discussion: Induction chemotherapy group was associated with lower survival rates than the primary surgery group with locally advanced carcinoma of the oral cavity. However, when primary tumor size was large (advanced T stage), induction chemotherapy group showed a similar survival rate. Especially, in terms of organ preservation, induction chemotherapy can be a better option to treat locally advanced (T3, 4) oral cavity cancer. doi:10.1016/j.oos.2009.06.112
O28. Randomized phase II study of concomitant chemoradiation using weekly carboplatin/paclitaxel/concomitant boost radiation with or without daily subcutaneous amifostine in patients with newly diagnosed locally advanced head and neck cancer R. Haddad a,b,*, P. Braschayko a, S. Sonis a,b, M. Posner a,b, L. Wirth a, R. Tishler a,b a b
Dana Farber Cancer Institute, United States Brigham and Women’s Hospital, United States
Introduction: A randomized phase II study was performedto investigate the efficacy/toxicity of combining concomitant boost
65
radiation and weekly carboplatin/paclitaxel with or without amifostine in patients with locally advanced SCCHN. Patients and methods: Patients with new diagnosis, locally advanced stage III or IV SCCHN received four weekly doses of carboplatin (AUC 1.5) and paclitaxel (45 mg/m2) concurrently with concomitant boost radiation consisting of 72 Gy in 42 fractions over 6 weeks (qd for 18 days, bid for 12 days). All patients were randomized to subcutaneous (SC) daily amifostine 500 mg (Arm A) or no amifostine (Arm B). Toxicity data were collected weekly and saliva collection was performed with and without citric acid stimulation. We also measured cytokine levels and assessed the levels in relation to mucositis grade. Results: Fifty-eight patients were enrolled, 29 in each arm. The majority were males (90%), had stage IV disease (82%) and had oropharynx primary sites (60%). Major toxicities encountered were similar in both arms and included grade 3 mucositis (75% Arm A and 70% Arm B) and grade 2 xerostomia (41% both arms). The median number of amifostine doses delivered was 28 with skin toxicity (Grade 3 in 11 patients) as the limiting factor. Saliva production showed no difference between the arms. Median follow up is 34 months and only five failures have been encountered (2 local, 3 distant) with overall survival 89%. Neck dissection was performed in 25 patients; 5/25 showed persistent disease and 4/5 are alive NED. The median time to PEG removal was 9.6 months in arm A and 10.4 months in arm B. Only one patient remains PEG dependent at this time. For cytokine levels, the general trend is an increase in pro-inflammatory cytokines (TNF, IL-1, and IL-6) and a decrease in anti-inflammatory cytokines (IL-13) as oral mucositis scores increase. No changes in CRP levels were noted. Discussion: Four weekly doses of carboplatin/paclitaxel with concomitant boost radiation is a highly effective regimen in this patient population with advanced SCCHN. Overall survival is 89%. The time to PEG removal is prolonged. Amifostine given subcutaneously did not improve the rates of xerostomia and mucositis with this fairly intensive chemoradiotherapy regimen. doi:10.1016/j.oos.2009.06.113
O29. Outcome and toxicity of hypofractionated radiotherapy in patients with head and neck cancers who are not suitable for curative treatment: ‘‘Christie scheme” R.J. Baatenburg de Jong *, A. Al-Mamgani, L. Tans, P.H.E. van Rooy, I. Noever, P. Levendag Erasmus MC, Netherlands Objectives: To retrospectively investigate the efficacy and safety of a palliative hypofractionated schedule of radiotherapy in patients with squamous cell carcinoma of the head and neck (HNSCC) unsuitable for curative treatment. Patients and methods: Between 1995 and 2006, 158 patients with HNSCC, unsuitable for curative treatment, were treated with a hypofractionated scheme of radiotherapy consisting of 16 fractions of 3.125 Gy. Endpoints of the study were response rates, progression-free survival, overall survival, toxicity, and quality of life (QoL). Results: Seventy-four percent of patients were male, 81% had stage IV disease and 31% had oropharyngeal cancer. Of the whole group, 45% had complete response, 28% partial response for an overall response rate of 73%, 6% had stable disease, and 21% progressed during or directly after completion of treatment. Median survival time was 17 months and 40% survived P1 year after the RT. Acute grade P3 skin and mucosal toxicities were observed in 45% and 65% of patients, respectively. While 45% experienced acute grade 3 dysphagia during treatment and required insertion of a feeding tube,
Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122
O27. The role of induction chemotherapy on survival of locally advanced oral cavity cancer K.H. Kim *, I.J. Choi, S.Y. An, J.H. Hah, T.K. Kwon, M.W. Sung Department of Otorhinolaryngology, Seoul National University College of Medicine, Republic of Korea Introduction: This study was conducted to determine the role of induction chemotherapy on survival in locally advanced (T3, 4) oral cancer. Methods: A retrospective analysis was performed on 89 eligible patients with stages III–IV American Joint Committee on Cancer (AJCC 2007) staging system squamous cell carcinoma of the oral cavity at the study department between 1987 and 2006. These patients received one of three treatments: Induction chemotherapy followed by surgery or RT (Group A, n = 38), Surgery or RT or Surgery with RT (Group B, n = 44) Concomitant chemoradiotherapy (Group C, n = 7). Induction chemotherapy mainly comprised two cycles of cisplatin/ 5-fluorouracil (FP). Results: When all 89 patients were analyzed, Group B (2-year overall survival rate: 69% disease free survival rate: 71%) showed significantly higher survival rates than Group A (2-year survival rate: 45% disease free survival rate 36%) and Group C (2-year survival rate: 33% disease free survival rate 33%). Within 48 patients with T3, T4 stage disease, there was no significant difference in overall survival and disease free survival between each group. Among 19 patients who underwent induction chemotherapy, organ preservation was successful in 15 (78.4%) patients. However, wide resection and free flap reconstruction was mandatory for all (14/14) patients who received surgical treatment. Discussion: Induction chemotherapy group was associated with lower survival rates than the primary surgery group with locally advanced carcinoma of the oral cavity. However, when primary tumor size was large (advanced T stage), induction chemotherapy group showed a similar survival rate. Especially, in terms of organ preservation, induction chemotherapy can be a better option to treat locally advanced (T3, 4) oral cavity cancer. doi:10.1016/j.oos.2009.06.112
O28. Randomized phase II study of concomitant chemoradiation using weekly carboplatin/paclitaxel/concomitant boost radiation with or without daily subcutaneous amifostine in patients with newly diagnosed locally advanced head and neck cancer R. Haddad a,b,*, P. Braschayko a, S. Sonis a,b, M. Posner a,b, L. Wirth a, R. Tishler a,b a b
Dana Farber Cancer Institute, United States Brigham and Women’s Hospital, United States
Introduction: A randomized phase II study was performedto investigate the efficacy/toxicity of combining concomitant boost
65
radiation and weekly carboplatin/paclitaxel with or without amifostine in patients with locally advanced SCCHN. Patients and methods: Patients with new diagnosis, locally advanced stage III or IV SCCHN received four weekly doses of carboplatin (AUC 1.5) and paclitaxel (45 mg/m2) concurrently with concomitant boost radiation consisting of 72 Gy in 42 fractions over 6 weeks (qd for 18 days, bid for 12 days). All patients were randomized to subcutaneous (SC) daily amifostine 500 mg (Arm A) or no amifostine (Arm B). Toxicity data were collected weekly and saliva collection was performed with and without citric acid stimulation. We also measured cytokine levels and assessed the levels in relation to mucositis grade. Results: Fifty-eight patients were enrolled, 29 in each arm. The majority were males (90%), had stage IV disease (82%) and had oropharynx primary sites (60%). Major toxicities encountered were similar in both arms and included grade 3 mucositis (75% Arm A and 70% Arm B) and grade 2 xerostomia (41% both arms). The median number of amifostine doses delivered was 28 with skin toxicity (Grade 3 in 11 patients) as the limiting factor. Saliva production showed no difference between the arms. Median follow up is 34 months and only five failures have been encountered (2 local, 3 distant) with overall survival 89%. Neck dissection was performed in 25 patients; 5/25 showed persistent disease and 4/5 are alive NED. The median time to PEG removal was 9.6 months in arm A and 10.4 months in arm B. Only one patient remains PEG dependent at this time. For cytokine levels, the general trend is an increase in pro-inflammatory cytokines (TNF, IL-1, and IL-6) and a decrease in anti-inflammatory cytokines (IL-13) as oral mucositis scores increase. No changes in CRP levels were noted. Discussion: Four weekly doses of carboplatin/paclitaxel with concomitant boost radiation is a highly effective regimen in this patient population with advanced SCCHN. Overall survival is 89%. The time to PEG removal is prolonged. Amifostine given subcutaneously did not improve the rates of xerostomia and mucositis with this fairly intensive chemoradiotherapy regimen. doi:10.1016/j.oos.2009.06.113
O29. Outcome and toxicity of hypofractionated radiotherapy in patients with head and neck cancers who are not suitable for curative treatment: ‘‘Christie scheme” R.J. Baatenburg de Jong *, A. Al-Mamgani, L. Tans, P.H.E. van Rooy, I. Noever, P. Levendag Erasmus MC, Netherlands Objectives: To retrospectively investigate the efficacy and safety of a palliative hypofractionated schedule of radiotherapy in patients with squamous cell carcinoma of the head and neck (HNSCC) unsuitable for curative treatment. Patients and methods: Between 1995 and 2006, 158 patients with HNSCC, unsuitable for curative treatment, were treated with a hypofractionated scheme of radiotherapy consisting of 16 fractions of 3.125 Gy. Endpoints of the study were response rates, progression-free survival, overall survival, toxicity, and quality of life (QoL). Results: Seventy-four percent of patients were male, 81% had stage IV disease and 31% had oropharyngeal cancer. Of the whole group, 45% had complete response, 28% partial response for an overall response rate of 73%, 6% had stable disease, and 21% progressed during or directly after completion of treatment. Median survival time was 17 months and 40% survived P1 year after the RT. Acute grade P3 skin and mucosal toxicities were observed in 45% and 65% of patients, respectively. While 45% experienced acute grade 3 dysphagia during treatment and required insertion of a feeding tube,
Oral AbstractsPoster ListOrals ListPan. Disc. & Symp. Abs.Keynote Abs.Keynote Bios.ProgramIAOOWelcomeCommittee Listings
Oral abstracts / Oral Oncology Supplement 3 (2009) 56–122