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Outcomes of T1 and T2 Glottic Carcinoma Treated with Definitive Radiotherapy at Cleveland Clinic: A 20 Year Experience
I. J. Radiation Oncology d Biology d Physics
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Volume 75, Number 3, Supplement, 2009
chemotherapy. Acute ocular toxicity was scored using the RTOG radiation morbidity criteria which rates the severity of conjunctivitis and keratitis. The paired LG were contoured separately on the initial treatment-planning CT scans, and the following dosimetric variables were recorded: maximum dose, mean dose, V10, V20, and V30. Dose-volume histogram (DVH) data were analyzed in relation to the incidence of acute and late complications. Results: The incidence of Grade 2+ acute and late toxicity related to LG dysfunction was 33% and 17%, respectively. The most commonly reported side effect was conjunctivitis/keratitis requiring artificial tears (6 patients) and/or antibiotics (3 patients). The only case of Grade 3 toxicity was a patient treated for nasal cavity cancer who developed corneal ulceration approximately 6 months after completing treatment. There were no reported Grade 4 complications. Spearman’s r analysis identified a significant correlation (p \ 0.05) between Grade 2+ ocular toxicity and V30. Four of the 5 patients (80%) with V30 to the ipsilateral LG in excess of 50% developed Grade 2+ acute toxicity compared to 2 of 13 (15%) with V30 less than 50%. V30.50% remained predictive of LG toxicity in the late setting. None of the other tested variables significantly predicted for acute or late LG toxicity. Conclusions: We identified a significant correlation between radiation dose to the LG and acute toxicity related to its dysfunction. Our data suggest that striving to maintain V30 less than 50% may significantly decrease the risk of Grade 3 ocular toxicity in the acute setting. Further studies are needed to validate these findings. Author Disclosure: R. Sreeraman, None; S. Doshi, None; J. Cui, None; M. Mathai, None; C.C. Yang, None; J.A. Purdy, None; A.M. Chen, None.
2527
Radiotherapy for Locally Advanced Hypopharyngeal Carcinoma - A Comparison between Definitive (Chemo-) Radiotherapy and Laryngectomy followed by Postoperative Radiotherapy
H. Nishimura1, R. Sasaki1, Y. Okamoto1, K. Yoshida1, T. Kawabe1, K. Nibu2, N. Ohtsuki2, M. Saitoh2, T. Soejima3, K. Sugimura4 Kobe University Department of Radiation Oncology, Kobe City, Japan, 2Kobe University Department of Head and Neck Surgery, Kobe City, Japan, 3Hyogo Cancer Center Department of Radiation Oncology, Akashi City, Japan, 4Kobe University Department of Radiology, Kobe City, Japan 1
Purpose/Objective(s): Locally advanced hypopharyngeal carcinoma remains a difficult disease to cure. Treatment strategy includes surgery, radiotherapy and chemotherapy, however, optimal treatment choice is still controversial. We retrospectively compared the treatment outcomes between definitive (chemo-) radiotherapy (RT) and laryngectomy followed by post operative radiotherapy (PORT) for locally advanced hypopharyngeal carcinoma. Materials/Methods: From August 2000 to July 2008, 92 patients with Stage III or IV hypopharyngeal carcinoma were treated with definitive RT or PORT in our institute. All patients were followed up more than 6 months or until any events. Forty patients received definitive RT and 52 received PORT. In definitive RT group, fifteen patients received neck node dissection prior to RT. In PORT group, all patients received total laryngectomy and neck node dissection prior to RT. There were 82 men and 10 women. Age ranged 45 to 89 years (median: 64). Ten patients were Stage III and 82 were Stage IV. Irradiated dose for definitive RT group was ranged 50 to 75 Gy (median: 66), for PORT group 46 to 70 Gy (median: 60). Thirty one patients (78%) received concurrent chemotherapy among definitive RT group, whereas 20 patients (38%) received concurrent chemotherapy among PORT group (p \ 0.05). Results: Median follow-up periods for all patients and surviving patients were 19 and 26 months, respectively. The 3-year (5-year) overall survival rates for all patients were 51% (41%). The 3-year (5-year) overall survival rates for definitive RT group and PORT group were 48% (27%) and 52% (49%), respectively (p = 0.94). There were 17 deaths among definitive radiotherapy group. Cause of death was primary disease for 13 patients, other cancers for 2, intercurrent disease for 2. There were 25 deaths among PORT group. Eighteen died of primary disease, four died of other cancers, three died of intercurrent disease. The 3-year (5-year) locoregional control rates for definitive RT group and PORT group were 60% (60%) and 80% (80%), respectively (p = 0.19). Three patients received salvage laryngectomy after definitive RT. Distant metastasis were developed in 10 patients (25%) among definitive RT group and 12 patients (23%) among PORT group (p = 0.83). Most patients experienced Grade 2 to 3 mucositis and odynophagia during acute phase. No sever late toxicities of Grade 3 or greater were recorded. Conclusions: Trend of better loco-regional control was observed among PORT group at the expense of laryngectomy, however, difference was not observed in survival rate. This study was a retrospective analysis and it might be underpowered to elucidate the benefit of surgical mutilation. Further accumulation of patients is warranted. Author Disclosure: H. Nishimura, None; R. Sasaki, None; Y. Okamoto, None; K. Yoshida, None; T. Kawabe, None; K. Nibu, None; N. Ohtsuki, None; M. Saitoh, None; T. Soejima, None; K. Sugimura, None.
2528
Outcomes of T1 and T2 Glottic Carcinoma Treated with Definitive Radiotherapy at Cleveland Clinic: A 20 Year Experience
M. K. Khan, S. Koyfman, G. H. Hunter, C. A. Reddy, J. P. Saxton Cleveland Clinic, Cleveland, OH Purpose/Objective(s): To review the outcome of 141 patients with T1 and T2 glottic cancer treated from 1986–2006 after obtaining IRB approval and to analyze factors predicting for poor outcome. Materials/Methods: Factors analyzed include: age, gender, race, smoking status, heavy alcohol use, tumor bulk (amount of cord involved), grade, histology, T-Stage (T2 vs. T1 and T2b vs. all T1/T2), anterior commissure (AC) involvement, supraglottic/subglottic extension, daily dose (#2 Gy vs. . 2 Gy), total dose, field arrangement (bilateral vs. unilateral), and total treatment time. The impact of these variables on local control (LC) is evaluated using Cox proportional hazards regression using univariate and multivariate analyses. LC, cause specific survival (CSS), and overall survival (OS) were calculated by actuarial analyses. Results: Median age, treatment duration, average dose, dose/fraction, and mean follow-up were 69 years, 43 days, 6820 cGy, 217 cGy/fx, and 54.6 months, respectively. 46%, 15%, 21%, and 18% of patients were T1a, T1b, T2a, and T2b, respectively. Prior to treatment 91% of patients had impaired voice, 73% noted significant improvement after treatment, while 8.5% noted worsening.
Proceedings of the 51st Annual ASTRO Meeting Mild chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively and one patient required a tracheostomy for severe laryngeal edema. There were 19 local failures in total with 6 occurring at the original tumor site. The 5-year and 10-year LC rates were 85% and 80.8 %, respectively. There were no local failures beyond ten years. By stage the five year LC was 94% (T1a), 82.6% (T1b), 82.4% (T2a), and 65% (T2b); the ten year LC was 87.4% (T1a), 82.6% (T1b), 82.4% (T2a), and 56.3% (T2b). On univariate analysis, LC, heavy alcohol consumption during diagnosis, anterior commissure involvement, T-Stage, lower dose, and subglottic extension were significant for poor LC (p # 0.05). On multivariate analysis analyzing stage as T1 vs. T2, only heavy alcohol use at diagnosis (p = .002) and involvement of AC (p = .02) were significant. On multivariate analysis analyzing stage T2b compared to the other 3 stage subgroups, heavy alcohol consumption at diagnosis (p = .0004), and stage T2b (p = .02) were significant for inferior LC. The five year CSS and OS was 95.9% and 76.8% for all, respectively. 22% of all patients developed a second primary cancer, with lung (28%) being the most common site. Conclusions: Radiotherapy provides excellent LC and CSS for T1–T2 glottic cancer, and yields excellent long term voice quality for most patients. The major cause of death is due to other causes including second malignancies and co-morbidities and not treatment failures. T2b tumors have inferior outcomes, and more aggressive management strategies should be explored. Author Disclosure: M.K. Khan, None; S. Koyfman, None; G.H. Hunter, None; C.A. Reddy, None; J.P. Saxton, None.
2529
Evaluation of Arc-based Intensity Modulated Radiotherapy for Head and Neck Cancer
1
M. Rao , W. Yang2, F. Chen1, K. Sheng2, J. Ye1, M. Vivek1, D. Shepard1, D. Cao1 1
Swedish Cancer Institute, Seattle, WA, 2University of Virginia Health Systems, Charlottesville, VA
Purpose/Objective(s): Tomotherapy and Volumetric Modulated Arc Therapy (VMAT) are two arc-based approaches to the delivery of intensity modulated radiation therapy (IMRT). The objective of this study is to compare treatment plans for head and neck (H&N) cancer using VMAT, helical tomotherapy and fixed field IMRT in terms of plan quality, delivery efficiency and accuracy. Materials/Methods: Six complex H&N cases involving multiple targets and multiple prescription levels were selected for this study. Treatment sites included 2 nasopharynx and 4 oropharynx cases. Three different treatment plans were generated for each case: (1) a 9-field IMRT plan; (2) a VMAT plan generated using the SmartArc inverse planning module in the Pinnacle3 treatment planning system and (3) a tomotherapy plan. To meet the treatment goals, two arcs were used in the VMAT plans for all 6 cases. VMAT plans were delivered on an Elekta SynergyÒ equipped with a conventional 80-leaf MLC (1 cm leaf width). Helical tomotherapy plans were delivered using a Tomotherapy HI_ART II system. An IBA MatriXX 2D ion chamber array was used for VMAT plan QA, and an ion chamber and films were used for tomotherapy plan QA. Measured and calculated dose distributions were compared using 2D gamma evaluation with 3%/3mm passing criteria. Results: Both VMAT and tomotherapy are capable of providing highly uniform target doses as compared with fixed field IMRT. On average, 98.0%, 98.4%, and 98.8% of the target volumes were covered with 95% of the prescribed dose for the fixed field, VMAT and tomotherapy plans, respectively. Tomotherapy plans achieved slightly better sparing of the parotid glands, spinal cord, brain stem, larynx, and oral cavity with an average mean organ dose that was 2.0% lower than VMAT and 5.1% lower than fixed field IMRT. The average delivery time of the VMAT plans was 4.9 minutes as compared with 7.5 minutes for tomotherapy and 12.7 minutes for fixed field IMRT. In terms of delivery accuracy, every plan in this study passed our institution’s IMRT verification criteria. Conclusions: As compared with fixed-field IMRT, VMAT and tomotherapy provide highly uniform target doses while improving the dosimetric sparing of critical structures. For complex H&N cases, VMAT technique is able to provide 35% reduction in delivery time as compared with tomotherapy. Author Disclosure: M. Rao, None; W. Yang, None; F. Chen, None; K. Sheng, None; J. Ye, None; M. Vivek, None; D. Shepard, None; D. Cao, None.
2530
Multi-institutional Analysis of Solitary Extramedullary Plasmacytoma of the Head and Neck Treated with Curative Radiotherapy
R. Sasaki1, T. Kawabe1, E. Abe2, N. Uchida3, K. Yasuda4, T. Uno5, M. Fujiwara6, Y. Shioyama7, Y. Shibamoto8, S. Yamada9 Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japan, 2Division of Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, 3Department of Radiation Oncology, Shimane University Faculty of Medicine, Izumo, Japan, 4Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan, 5Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan, 6Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan, 7Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 8Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 9Department of Radiation Oncology, Tohoku University, Sendai, Japan 1
Purpose/Objective(s): Extramedullary plasmacytomas of the head and neck regions (EMPHN) are rare plasma cell neoplasms. The objective was to define the effectiveness of radiotherapy in the treatment of patients with EMPHN, and to find a hallmark of the strategy against EMPHN. Materials/Methods: A multi-institutional retrospective review between 1983 and 2008 was performed. Sixty-four patients with EMPHN were registered from 23 Japanese institutions. There were 42 male and 22 female patients. Median age of patients was 64 years old (rang: 12–83). There were 46 patients with performance status (PS by ECOG) 0, 17 patients with PS1, and a patient with PS2. Tumor sites were nasal or paranasal cavities in 35 (55%) patients, oropharynx or nasopharynx in 14 (22%) patients, orbital in 6 (9%) patients, larynx in 3 (5%) patients, and other several sites in 6 patients. Twenty-one (33%) patients were treated with surgical resection proceeded to radiotherapy, while 43 (67%) patients were treated with radiotherapy without surgery. Median radiation dose administered was 50 Gy (range, 30–64 Gy). Chemotherapies were administered in 9 patients (14%). Survival data were calculated by the Kaplan-Meyer method. Progression-free survival was calculated by consideration of all kinds of deaths, either local or distant failure of EMPHN, and progression to multiple myelomas.
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chemotherapy. Acute ocular toxicity was scored using the RTOG radiation morbidity criteria which rates the severity of conjunctivitis and keratitis. The paired LG were contoured separately on the initial treatment-planning CT scans, and the following dosimetric variables were recorded: maximum dose, mean dose, V10, V20, and V30. Dose-volume histogram (DVH) data were analyzed in relation to the incidence of acute and late complications. Results: The incidence of Grade 2+ acute and late toxicity related to LG dysfunction was 33% and 17%, respectively. The most commonly reported side effect was conjunctivitis/keratitis requiring artificial tears (6 patients) and/or antibiotics (3 patients). The only case of Grade 3 toxicity was a patient treated for nasal cavity cancer who developed corneal ulceration approximately 6 months after completing treatment. There were no reported Grade 4 complications. Spearman’s r analysis identified a significant correlation (p \ 0.05) between Grade 2+ ocular toxicity and V30. Four of the 5 patients (80%) with V30 to the ipsilateral LG in excess of 50% developed Grade 2+ acute toxicity compared to 2 of 13 (15%) with V30 less than 50%. V30.50% remained predictive of LG toxicity in the late setting. None of the other tested variables significantly predicted for acute or late LG toxicity. Conclusions: We identified a significant correlation between radiation dose to the LG and acute toxicity related to its dysfunction. Our data suggest that striving to maintain V30 less than 50% may significantly decrease the risk of Grade 3 ocular toxicity in the acute setting. Further studies are needed to validate these findings. Author Disclosure: R. Sreeraman, None; S. Doshi, None; J. Cui, None; M. Mathai, None; C.C. Yang, None; J.A. Purdy, None; A.M. Chen, None.
2527
Radiotherapy for Locally Advanced Hypopharyngeal Carcinoma - A Comparison between Definitive (Chemo-) Radiotherapy and Laryngectomy followed by Postoperative Radiotherapy
H. Nishimura1, R. Sasaki1, Y. Okamoto1, K. Yoshida1, T. Kawabe1, K. Nibu2, N. Ohtsuki2, M. Saitoh2, T. Soejima3, K. Sugimura4 Kobe University Department of Radiation Oncology, Kobe City, Japan, 2Kobe University Department of Head and Neck Surgery, Kobe City, Japan, 3Hyogo Cancer Center Department of Radiation Oncology, Akashi City, Japan, 4Kobe University Department of Radiology, Kobe City, Japan 1
Purpose/Objective(s): Locally advanced hypopharyngeal carcinoma remains a difficult disease to cure. Treatment strategy includes surgery, radiotherapy and chemotherapy, however, optimal treatment choice is still controversial. We retrospectively compared the treatment outcomes between definitive (chemo-) radiotherapy (RT) and laryngectomy followed by post operative radiotherapy (PORT) for locally advanced hypopharyngeal carcinoma. Materials/Methods: From August 2000 to July 2008, 92 patients with Stage III or IV hypopharyngeal carcinoma were treated with definitive RT or PORT in our institute. All patients were followed up more than 6 months or until any events. Forty patients received definitive RT and 52 received PORT. In definitive RT group, fifteen patients received neck node dissection prior to RT. In PORT group, all patients received total laryngectomy and neck node dissection prior to RT. There were 82 men and 10 women. Age ranged 45 to 89 years (median: 64). Ten patients were Stage III and 82 were Stage IV. Irradiated dose for definitive RT group was ranged 50 to 75 Gy (median: 66), for PORT group 46 to 70 Gy (median: 60). Thirty one patients (78%) received concurrent chemotherapy among definitive RT group, whereas 20 patients (38%) received concurrent chemotherapy among PORT group (p \ 0.05). Results: Median follow-up periods for all patients and surviving patients were 19 and 26 months, respectively. The 3-year (5-year) overall survival rates for all patients were 51% (41%). The 3-year (5-year) overall survival rates for definitive RT group and PORT group were 48% (27%) and 52% (49%), respectively (p = 0.94). There were 17 deaths among definitive radiotherapy group. Cause of death was primary disease for 13 patients, other cancers for 2, intercurrent disease for 2. There were 25 deaths among PORT group. Eighteen died of primary disease, four died of other cancers, three died of intercurrent disease. The 3-year (5-year) locoregional control rates for definitive RT group and PORT group were 60% (60%) and 80% (80%), respectively (p = 0.19). Three patients received salvage laryngectomy after definitive RT. Distant metastasis were developed in 10 patients (25%) among definitive RT group and 12 patients (23%) among PORT group (p = 0.83). Most patients experienced Grade 2 to 3 mucositis and odynophagia during acute phase. No sever late toxicities of Grade 3 or greater were recorded. Conclusions: Trend of better loco-regional control was observed among PORT group at the expense of laryngectomy, however, difference was not observed in survival rate. This study was a retrospective analysis and it might be underpowered to elucidate the benefit of surgical mutilation. Further accumulation of patients is warranted. Author Disclosure: H. Nishimura, None; R. Sasaki, None; Y. Okamoto, None; K. Yoshida, None; T. Kawabe, None; K. Nibu, None; N. Ohtsuki, None; M. Saitoh, None; T. Soejima, None; K. Sugimura, None.
2528
Outcomes of T1 and T2 Glottic Carcinoma Treated with Definitive Radiotherapy at Cleveland Clinic: A 20 Year Experience
M. K. Khan, S. Koyfman, G. H. Hunter, C. A. Reddy, J. P. Saxton Cleveland Clinic, Cleveland, OH Purpose/Objective(s): To review the outcome of 141 patients with T1 and T2 glottic cancer treated from 1986–2006 after obtaining IRB approval and to analyze factors predicting for poor outcome. Materials/Methods: Factors analyzed include: age, gender, race, smoking status, heavy alcohol use, tumor bulk (amount of cord involved), grade, histology, T-Stage (T2 vs. T1 and T2b vs. all T1/T2), anterior commissure (AC) involvement, supraglottic/subglottic extension, daily dose (#2 Gy vs. . 2 Gy), total dose, field arrangement (bilateral vs. unilateral), and total treatment time. The impact of these variables on local control (LC) is evaluated using Cox proportional hazards regression using univariate and multivariate analyses. LC, cause specific survival (CSS), and overall survival (OS) were calculated by actuarial analyses. Results: Median age, treatment duration, average dose, dose/fraction, and mean follow-up were 69 years, 43 days, 6820 cGy, 217 cGy/fx, and 54.6 months, respectively. 46%, 15%, 21%, and 18% of patients were T1a, T1b, T2a, and T2b, respectively. Prior to treatment 91% of patients had impaired voice, 73% noted significant improvement after treatment, while 8.5% noted worsening.
Proceedings of the 51st Annual ASTRO Meeting Mild chronic laryngeal edema and dysphagia were noted in 18% and 7%, respectively and one patient required a tracheostomy for severe laryngeal edema. There were 19 local failures in total with 6 occurring at the original tumor site. The 5-year and 10-year LC rates were 85% and 80.8 %, respectively. There were no local failures beyond ten years. By stage the five year LC was 94% (T1a), 82.6% (T1b), 82.4% (T2a), and 65% (T2b); the ten year LC was 87.4% (T1a), 82.6% (T1b), 82.4% (T2a), and 56.3% (T2b). On univariate analysis, LC, heavy alcohol consumption during diagnosis, anterior commissure involvement, T-Stage, lower dose, and subglottic extension were significant for poor LC (p # 0.05). On multivariate analysis analyzing stage as T1 vs. T2, only heavy alcohol use at diagnosis (p = .002) and involvement of AC (p = .02) were significant. On multivariate analysis analyzing stage T2b compared to the other 3 stage subgroups, heavy alcohol consumption at diagnosis (p = .0004), and stage T2b (p = .02) were significant for inferior LC. The five year CSS and OS was 95.9% and 76.8% for all, respectively. 22% of all patients developed a second primary cancer, with lung (28%) being the most common site. Conclusions: Radiotherapy provides excellent LC and CSS for T1–T2 glottic cancer, and yields excellent long term voice quality for most patients. The major cause of death is due to other causes including second malignancies and co-morbidities and not treatment failures. T2b tumors have inferior outcomes, and more aggressive management strategies should be explored. Author Disclosure: M.K. Khan, None; S. Koyfman, None; G.H. Hunter, None; C.A. Reddy, None; J.P. Saxton, None.
2529
Evaluation of Arc-based Intensity Modulated Radiotherapy for Head and Neck Cancer
1
M. Rao , W. Yang2, F. Chen1, K. Sheng2, J. Ye1, M. Vivek1, D. Shepard1, D. Cao1 1
Swedish Cancer Institute, Seattle, WA, 2University of Virginia Health Systems, Charlottesville, VA
Purpose/Objective(s): Tomotherapy and Volumetric Modulated Arc Therapy (VMAT) are two arc-based approaches to the delivery of intensity modulated radiation therapy (IMRT). The objective of this study is to compare treatment plans for head and neck (H&N) cancer using VMAT, helical tomotherapy and fixed field IMRT in terms of plan quality, delivery efficiency and accuracy. Materials/Methods: Six complex H&N cases involving multiple targets and multiple prescription levels were selected for this study. Treatment sites included 2 nasopharynx and 4 oropharynx cases. Three different treatment plans were generated for each case: (1) a 9-field IMRT plan; (2) a VMAT plan generated using the SmartArc inverse planning module in the Pinnacle3 treatment planning system and (3) a tomotherapy plan. To meet the treatment goals, two arcs were used in the VMAT plans for all 6 cases. VMAT plans were delivered on an Elekta SynergyÒ equipped with a conventional 80-leaf MLC (1 cm leaf width). Helical tomotherapy plans were delivered using a Tomotherapy HI_ART II system. An IBA MatriXX 2D ion chamber array was used for VMAT plan QA, and an ion chamber and films were used for tomotherapy plan QA. Measured and calculated dose distributions were compared using 2D gamma evaluation with 3%/3mm passing criteria. Results: Both VMAT and tomotherapy are capable of providing highly uniform target doses as compared with fixed field IMRT. On average, 98.0%, 98.4%, and 98.8% of the target volumes were covered with 95% of the prescribed dose for the fixed field, VMAT and tomotherapy plans, respectively. Tomotherapy plans achieved slightly better sparing of the parotid glands, spinal cord, brain stem, larynx, and oral cavity with an average mean organ dose that was 2.0% lower than VMAT and 5.1% lower than fixed field IMRT. The average delivery time of the VMAT plans was 4.9 minutes as compared with 7.5 minutes for tomotherapy and 12.7 minutes for fixed field IMRT. In terms of delivery accuracy, every plan in this study passed our institution’s IMRT verification criteria. Conclusions: As compared with fixed-field IMRT, VMAT and tomotherapy provide highly uniform target doses while improving the dosimetric sparing of critical structures. For complex H&N cases, VMAT technique is able to provide 35% reduction in delivery time as compared with tomotherapy. Author Disclosure: M. Rao, None; W. Yang, None; F. Chen, None; K. Sheng, None; J. Ye, None; M. Vivek, None; D. Shepard, None; D. Cao, None.
2530
Multi-institutional Analysis of Solitary Extramedullary Plasmacytoma of the Head and Neck Treated with Curative Radiotherapy
R. Sasaki1, T. Kawabe1, E. Abe2, N. Uchida3, K. Yasuda4, T. Uno5, M. Fujiwara6, Y. Shioyama7, Y. Shibamoto8, S. Yamada9 Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Japan, 2Division of Radiation Oncology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan, 3Department of Radiation Oncology, Shimane University Faculty of Medicine, Izumo, Japan, 4Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan, 5Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan, 6Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan, 7Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 8Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 9Department of Radiation Oncology, Tohoku University, Sendai, Japan 1
Purpose/Objective(s): Extramedullary plasmacytomas of the head and neck regions (EMPHN) are rare plasma cell neoplasms. The objective was to define the effectiveness of radiotherapy in the treatment of patients with EMPHN, and to find a hallmark of the strategy against EMPHN. Materials/Methods: A multi-institutional retrospective review between 1983 and 2008 was performed. Sixty-four patients with EMPHN were registered from 23 Japanese institutions. There were 42 male and 22 female patients. Median age of patients was 64 years old (rang: 12–83). There were 46 patients with performance status (PS by ECOG) 0, 17 patients with PS1, and a patient with PS2. Tumor sites were nasal or paranasal cavities in 35 (55%) patients, oropharynx or nasopharynx in 14 (22%) patients, orbital in 6 (9%) patients, larynx in 3 (5%) patients, and other several sites in 6 patients. Twenty-one (33%) patients were treated with surgical resection proceeded to radiotherapy, while 43 (67%) patients were treated with radiotherapy without surgery. Median radiation dose administered was 50 Gy (range, 30–64 Gy). Chemotherapies were administered in 9 patients (14%). Survival data were calculated by the Kaplan-Meyer method. Progression-free survival was calculated by consideration of all kinds of deaths, either local or distant failure of EMPHN, and progression to multiple myelomas.
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