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P2.116. Daily concurrent preoperative chemoradiotherapy using NewSuperselectiveIntra-arterial infusion via superficial temporal artery for oral cancer – Cervical lymphnode metastasis
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198
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Methods: Forty-nine patients with advanced head and neck cancer of the oral cavity, oropharynx, hypopharynx, larynx or nasopharynx treated with CRT were included. All patients received pretreatment exercises. Twenty-four received regular swallowing exercises (Standard group) and 25 used a simplified swallowing exercise regime based on the Therabite Jaw Motion Rehabilitation System (Experimental group). Before and approximately 10 weeks after CRT, all patients were assessed by means of a structured, multidimensional protocol (i.e. videofluoroscopy, mouth opening measurement, and oral intake and pain assessments). Results: Comparing the two exercise groups the Therabite group showed significant less residue above or below the valleculae swallowing Omnipaque coated cake (P = .021) compared with the Standard group. The Therabite group also scored significant less pain than the Standard group (p = .016). Comparing the pre and post measurements an average decrease in mouth opening of 6% was shown. Analyzing the tube dependency 78% (38/49; measured immediately after CRT) and 37% (18/49; 10 weeks after CRT) of the patients were tube dependent after treatment. These results shows a major significant progress (P = .004) compared with the results (90%; 83/92 and 70%; 64/92) of a comparable study by Ackerstaff et al. (2008). Conclusion: Pretreatment exercises in head and neck cancer patients treated with chemoradiation seems to be effective for reducing the amount and/or severity of various functional outcomes pre – and early-posttreatment. Part of the study is supported by an unrestricted research grant from Atos Medical, Hörby, Sweden. doi:10.1016/j.oos.2009.06.518
P2.115. Definitive accelerated radiotherapy for head and neck cancer patients – The results of organ preservation and prognostic-factor analysis of CAIR-2 phase III trial K. Skladowski*, A. Wygoda, A. Maciejewski, T. Rutkowski, S. Poltorak, B. Maciejewski Institute of Oncology – Maria Sklodowska-Curie Memorial Cancer Center, Poland Introduction: Since two years there is the EBM altered fractionations have offered small, but significant advantage in survival of head and neck cancer patients. Accelerated radiotherapy (ART) without total dose reduction presents the subgroup of those fractionations which were given most frequently and were brought the lowest risk of loco-regional recurrence. In Gliwice Institute of Oncology, between 1998 and 2006, phase III trial on such two definitive ART schedules having identical overall treatment times but different timing of dose-delivery - weekend-in or weekend-off – has been undergoing. Methods: In CAIR arm fraction-dose was given once-a-day, regularly at 24 h interval, including Saturdays and Sundays. In concomitant boost (CB) arm the dose was delivered once-a-day at Mondays, Wednesdays and Thursdays and twice-a-day with 8 h interval at Tuesdays and Fridays. Patients with moderate advanced SQCC were stratified per tumour site (larynx 48%, oropharynx 34%, oral cavity 9%, hypopharynx 9%) and stage (T2N0 31%, T2N1 10%, T3N0 22%, T3N1 13%, T4N0 12%, T4N1 12%). 3DRT technique and fractionation parameters remained within the ranges: 66.6–72Gy of total dose, 37–40 fractions and 37–40 days. Results: Median follow-up is 70 months. Generally, for all trial end-points similar rates for both schedules were noted - at 5 years LC was 67% in the CAIR and 68% in CB arm, DFS and OS rates were respectively 38% vs. 44% and 50 vs. 55% and come of, among others, the second primary tumours (36 pts) and the distant metastases (11
pts). Mucositis was the main acute toxicity with the same incidence in the arms. Actuarial 5-year grade 3–4 morbidity-free survival was 95% for both treatments. In 24 out of 104 T-failures (23% pts) and in 10 out of 35 N-failures (29% pts) salvage surgery was performed, including planned neck dissection. Thus, the overall rate of pts who survive 5-year with LC and organ preservation was 65%. Clinical T stage has been the only prognostic factor for both LC and OS (p = 0.00011). Conclusions: Gliwice CAIR-2 study has yielded the EBM that weekend-off in ART with no compromise of total dose has no impact on tumour cure for head and neck cancer patients. For moderate advanced head and neck cancer patients the probability of long-term local control with organ preservation and no serious toxicity is pretty high and the risk of distant metastases is low, what suggests that such ART could be worthy of use instead of more toxic concurrent chemo-radiation. doi:10.1016/j.oos.2009.06.519
P2.116. Daily concurrent preoperative chemoradiotherapy using NewSuperselectiveIntra-arterial infusion via superficial temporal artery for oral cancer – Cervical lymphnode metastasis N. Yamamoto*, T. Shigetomi, M. Nishikawa, D. Mizuno, H. Furue, F. Sato Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Japan Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicin, Japan Patients with head and neck squamous cell cancers (HNSC) of stages III and IV have a poor outcome, often losing important functions such as swallowing and speech despite combined surgery and radiotherapy. Two-thirds of such patients die of local recurrence and disseminated metastasis in spite of salvage therapy. Conventional adjuvant chemotherapy is often difficult for HNSC patients, since many of them suffer from associated chronic oral, respiratory and gastrointestinal diseases due to tobacco and alcohol in addition to having poor nutritional and oral hygienic conditions. We developed a new method of superselective intra-arterial infusion via the superficial temporal artery. Forty six advanced head and neck cancer patients with cervical lymph node metastasis were treated by superselective intra-arterial chemotherapy using docetaxel (DOC) and ciplatin (CDDP) from 2000 to 2008. Radiotherapy (total dose: 40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 60 mg/m2,15 mg/m2/week) and CDDP (total dose: 100 mg/m2, 5 mg/m2/day) were performed, followed by surgery. The pathological effects of lymph node metastasis after surgery were grade III, IV (Oboshi- Shimosato classification) in level I, II. This method promises to be the strategy of oral cancer with cervical lymph node metastasis. doi:10.1016/j.oos.2009.06.520
P2.117. The pattern evaluation of healing processess of acute mucosal reactions in irradiated patients with oral and oropharyngeal cancer A. Wygoda*, K. Skladowski, T. Rutkowski, M. Hutnik, B. Pilecki, M. Golen Ist Department of Radiation Oncology, Cancer Center and Institute of Oncology, Maria Sklodowska-Curie Memorial, Gliwice Branch, Poland
198
Poster session II / Oral Oncology Supplement 3 (2009) 162–200
Methods: Forty-nine patients with advanced head and neck cancer of the oral cavity, oropharynx, hypopharynx, larynx or nasopharynx treated with CRT were included. All patients received pretreatment exercises. Twenty-four received regular swallowing exercises (Standard group) and 25 used a simplified swallowing exercise regime based on the Therabite Jaw Motion Rehabilitation System (Experimental group). Before and approximately 10 weeks after CRT, all patients were assessed by means of a structured, multidimensional protocol (i.e. videofluoroscopy, mouth opening measurement, and oral intake and pain assessments). Results: Comparing the two exercise groups the Therabite group showed significant less residue above or below the valleculae swallowing Omnipaque coated cake (P = .021) compared with the Standard group. The Therabite group also scored significant less pain than the Standard group (p = .016). Comparing the pre and post measurements an average decrease in mouth opening of 6% was shown. Analyzing the tube dependency 78% (38/49; measured immediately after CRT) and 37% (18/49; 10 weeks after CRT) of the patients were tube dependent after treatment. These results shows a major significant progress (P = .004) compared with the results (90%; 83/92 and 70%; 64/92) of a comparable study by Ackerstaff et al. (2008). Conclusion: Pretreatment exercises in head and neck cancer patients treated with chemoradiation seems to be effective for reducing the amount and/or severity of various functional outcomes pre – and early-posttreatment. Part of the study is supported by an unrestricted research grant from Atos Medical, Hörby, Sweden. doi:10.1016/j.oos.2009.06.518
P2.115. Definitive accelerated radiotherapy for head and neck cancer patients – The results of organ preservation and prognostic-factor analysis of CAIR-2 phase III trial K. Skladowski*, A. Wygoda, A. Maciejewski, T. Rutkowski, S. Poltorak, B. Maciejewski Institute of Oncology – Maria Sklodowska-Curie Memorial Cancer Center, Poland Introduction: Since two years there is the EBM altered fractionations have offered small, but significant advantage in survival of head and neck cancer patients. Accelerated radiotherapy (ART) without total dose reduction presents the subgroup of those fractionations which were given most frequently and were brought the lowest risk of loco-regional recurrence. In Gliwice Institute of Oncology, between 1998 and 2006, phase III trial on such two definitive ART schedules having identical overall treatment times but different timing of dose-delivery - weekend-in or weekend-off – has been undergoing. Methods: In CAIR arm fraction-dose was given once-a-day, regularly at 24 h interval, including Saturdays and Sundays. In concomitant boost (CB) arm the dose was delivered once-a-day at Mondays, Wednesdays and Thursdays and twice-a-day with 8 h interval at Tuesdays and Fridays. Patients with moderate advanced SQCC were stratified per tumour site (larynx 48%, oropharynx 34%, oral cavity 9%, hypopharynx 9%) and stage (T2N0 31%, T2N1 10%, T3N0 22%, T3N1 13%, T4N0 12%, T4N1 12%). 3DRT technique and fractionation parameters remained within the ranges: 66.6–72Gy of total dose, 37–40 fractions and 37–40 days. Results: Median follow-up is 70 months. Generally, for all trial end-points similar rates for both schedules were noted - at 5 years LC was 67% in the CAIR and 68% in CB arm, DFS and OS rates were respectively 38% vs. 44% and 50 vs. 55% and come of, among others, the second primary tumours (36 pts) and the distant metastases (11
pts). Mucositis was the main acute toxicity with the same incidence in the arms. Actuarial 5-year grade 3–4 morbidity-free survival was 95% for both treatments. In 24 out of 104 T-failures (23% pts) and in 10 out of 35 N-failures (29% pts) salvage surgery was performed, including planned neck dissection. Thus, the overall rate of pts who survive 5-year with LC and organ preservation was 65%. Clinical T stage has been the only prognostic factor for both LC and OS (p = 0.00011). Conclusions: Gliwice CAIR-2 study has yielded the EBM that weekend-off in ART with no compromise of total dose has no impact on tumour cure for head and neck cancer patients. For moderate advanced head and neck cancer patients the probability of long-term local control with organ preservation and no serious toxicity is pretty high and the risk of distant metastases is low, what suggests that such ART could be worthy of use instead of more toxic concurrent chemo-radiation. doi:10.1016/j.oos.2009.06.519
P2.116. Daily concurrent preoperative chemoradiotherapy using NewSuperselectiveIntra-arterial infusion via superficial temporal artery for oral cancer – Cervical lymphnode metastasis N. Yamamoto*, T. Shigetomi, M. Nishikawa, D. Mizuno, H. Furue, F. Sato Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Japan Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicin, Japan Patients with head and neck squamous cell cancers (HNSC) of stages III and IV have a poor outcome, often losing important functions such as swallowing and speech despite combined surgery and radiotherapy. Two-thirds of such patients die of local recurrence and disseminated metastasis in spite of salvage therapy. Conventional adjuvant chemotherapy is often difficult for HNSC patients, since many of them suffer from associated chronic oral, respiratory and gastrointestinal diseases due to tobacco and alcohol in addition to having poor nutritional and oral hygienic conditions. We developed a new method of superselective intra-arterial infusion via the superficial temporal artery. Forty six advanced head and neck cancer patients with cervical lymph node metastasis were treated by superselective intra-arterial chemotherapy using docetaxel (DOC) and ciplatin (CDDP) from 2000 to 2008. Radiotherapy (total dose: 40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using DOC (total dose: 60 mg/m2,15 mg/m2/week) and CDDP (total dose: 100 mg/m2, 5 mg/m2/day) were performed, followed by surgery. The pathological effects of lymph node metastasis after surgery were grade III, IV (Oboshi- Shimosato classification) in level I, II. This method promises to be the strategy of oral cancer with cervical lymph node metastasis. doi:10.1016/j.oos.2009.06.520
P2.117. The pattern evaluation of healing processess of acute mucosal reactions in irradiated patients with oral and oropharyngeal cancer A. Wygoda*, K. Skladowski, T. Rutkowski, M. Hutnik, B. Pilecki, M. Golen Ist Department of Radiation Oncology, Cancer Center and Institute of Oncology, Maria Sklodowska-Curie Memorial, Gliwice Branch, Poland