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Phase II Trial of Docetaxel and Cisplatin Neoadjuvant Chemotherapy Followed by Intensity Modulated Radiation Therapy With Concurrent Cisplatin in Advanced Nasopharyngeal Carcinoma
Digital Poster Discussion Abstracts S207
Volume 84 Number 3S Supplement 2012 Materials/Methods: We retrospectively studied 46 patients with OPSCC treated with CRT and who prospectively underwent baseline and posttreatment videofluoroscopic swallowing studies (VFSS) from 2007-2010. Amongst these patients, patients with identified laryngeal penetration and/or aspiration (PAS) served as the study population and patients without any identified VFSS complications served as the control cohort. Individual suprahyoid muscles were identified on the planning CT based on anatomic landmarks provided by an expert otolaryngologist (EM). This process was validated with two independent investigators. The GH, MH, AD, and HG muscle groups were collectively referred to as the floor of mouth muscles (FoM). After contouring these structures, the treatment plan for each patient was recalculated to obtain specific doses and dose volumes to these muscle groups. Comparative analysis was performed with the non-parametric Mann-Whitney test. Logistic regression analysis was used to identify model FoM dosimetric factors that may be predictive for an abnormal VFS. Results: Significant differences in the minimum, maximum, mean, median, and various volumetric doses were identified between patients with normal and abnormal VFSS PAS. Logistic regression identified the FoM V45 to be predictive of an abnormal VFS (p Z 0.026). Conclusions: The data suggests that the dose and volume delivered to the collective FoM muscles may be associated with an increased risk of VFSS identified laryngeal penetration and aspiration. Further prospective evaluation of the doses delivered to these muscles is warranted to characterize the dose-volume relationship for injury. Author Disclosure: R. Kumar: None. H. Starmer: None. S. Alcorn: None. E. Murano: None. Y. Le: None. H. Quon: None.
1104 Multinational Survey on Delivery of Radiation Therapy for Nasopharyngeal Carcinoma J.J. Lu,1 J. Cheng,2 J. Pan,3 S. Lin,3 Z. Qi,4 Y. Sun,4 J. Yi,5 L. Gao,6 N. Cheng,7 I.W. Tham1, et al.; 1National University Cancer Institute, Singapore (NCIS), Singapore, Singapore, 2National Taiwan University Hospital, Taipei, Taiwan, 3Fujian Provincial Tumor Hospital, Fuzhou, Fujian, China, 4Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China, 5Cancer Hospital of the Chinese Academy of Science, Beijing, China, 6Cancer Hospital of the Chinese Academy of Science, Beijing, China, 7West China Hospital of Sichuan University, Chengdu, Sichuan, China Purpose/Objective(s): Advanced radiation therapy techniques play a critical role in the treatment of nasopharyngeal cancer (NPC). However, optimal utilization of technology has not been determined. There is significant variation of practice between centers. We established a consortium of tertiary teaching hospitals in the endemic region of NPC across East and Southeast Asia, to prospectively collect data and initiate large studies for this disease. Materials/Methods: We collated information from 7 centers in Singapore, Mainland China, Taiwan and Hong Kong to survey the current standard of care for NPC. Six institutions completed a questionnaire with 91 items concerning pre-treatment, simulation, planning, and radiation therapy delivery characteristics. Results: All centers treat 1,800-5,900 patients annually, have 4 treatment machines each, and have site sub-specialized radiation oncologists. Each center treats 110-2,500 NPC patients annually, with a total of 3,900 new cases per year for the consortium. Close agreement was observed in many aspects of care. All centers perform MRI of the head and neck and systemic staging prior to definitive treatment. All use neoadjuvant chemotherapy for locally advanced disease, especially T4 or N3 patients. All stage III/IV patients also receive concurrent cisplatin chemotherapy, either weekly or three-weekly. Four sites use intensity modulation radiation therapy (IMRT) to treat all NPC patients; the other two use IMRT in 75-80% of patients. All start RT within 2 weeks of simulation. All treat with 2 dose levels using the simultaneous integrated boost technique, with 70 Gy in 33 fractions being the most common fractionation. Significant differences in practice were also observed. Half the centers routinely monitor blood Epstein-Barr viral deoxyribonucleic acid levels. Three centers routinely offer adjuvant
chemotherapy. Only one site would routinely offer concurrent chemotherapy for all stage II patients; the others would select patients with N1 disease, or large primary or nodal disease. Two sites would routinely fuse MRI to computed tomography (CT) simulation images. Three sites would almost never use LINAC-based rotational therapy for NPC; the others use it for <50% of their cases. Half the centers define CTV60 Gy using gross disease with an expansion; the other half would also include protocolized anatomical structures. In the five centers with CT-based image-guidance LINACs, one would perform scans daily, two would perform them weekly, and two would perform them on days 1 to 3 or 4, then weekly thereafter. Three centers have a patient-specific quality assurance. Conclusions: This survey highlights many similarities in care for NPC, and identifies “grey areas” where practices are different across centers. These divergent views will form the basis for future prospective studies to identify the standard of care for NPC. Author Disclosure: J.J. Lu: E. Research Grant; Research supported, in part, by Elekta. J. Cheng: None. J. Pan: None. S. Lin: None. Z. Qi: None. Y. Sun: None. J. Yi: None. L. Gao: None. N. Cheng: None. I.W. Tham: None.
1105 Phase II Trial of Docetaxel and Cisplatin Neoadjuvant Chemotherapy Followed by Intensity Modulated Radiation Therapy With Concurrent Cisplatin in Advanced Nasopharyngeal Carcinoma Y. Zhong, Y. Zhou, C. Xie, X. Wang, F. Zhou, and G. Chen; Wuhan University Zhongnan Hospital, Wuhan, China Purpose/Objective(s): This study aimed to evaluate the feasibility and efficacy of docetaxel and cisplatin neoadjuvant chemotherapy followed by intensity modulated radiation therapy (IMRT) with concurrent cisplatin in patients with locally advanced nasopharyngeal carcinoma. Materials/Methods: From June 2008 until October 2010, 46 patients diagnosed with stage III to IVB nasopharyngeal carcinoma were recruited in this phase II trial. All patients received 2 cycles of docetaxel (75 mg/m2) plus cisplatin (75 mg/m2) on day 1 every 3 weeks, followed by intensitymodulated radiation therapy (72 Gy/33F/6.5-7w) with concurrent cisplatin (75 mg/m2) every 3 weeks. Results: Among these patients, 45 patients completed both neoadjuvant chemotherapy and concurrent chemoradiation therapy. The objective complete response rates and partial response rates were 28.3%, 56.5% after neoadjuvant chemotherapy and 91.3%, 8.7% after concurrent chemoradiation therapy, respectively. The median follow-up time was 26 months (range, 12-39 months). One patients experienced regional recurrence and four patients developed distant metastasis. The 3-year overall survival rate and progression-free survival rate were 94.1% and 72.7%, respectively. Neutropenia (37.0%) and vomiting (28.3%) were the most common acute grades 3-4 toxicities during neoadjuvant chemotherapy while mucositis (30.4%), xerostomia (30.4%), skin (21.7%) were the most common grades 3-4 toxicities during concurrent chemoradiation therapy. Xerostomia (73.9%), dysphagia (56.5%), hear loss (30.4%) and skin (21.7%) were the common late grade 1-2 radiation toxicities. There were no grades 3-4 late radiation toxicity. Conclusions: Neoadjuvant docetaxel-cisplatin followed by IMRT with concurrent cisplatin was well feasible and effective in treating local advanced nasopharyngeal carcinoma. Further investigation to test this strategy is warranted. Author Disclosure: Y. Zhong: None. Y. Zhou: None. C. Xie: None. X. Wang: None. F. Zhou: None. G. Chen: None.
1106 A Matched Pair Comparison of Intensity Modulated Radiation Therapy With Cetuximab Versus Intensity Modulated Radiation Therapy With Platinum-based Chemotherapy for Locally Advanced Head-and-Neck Cancer J. Huang,1 A. Baschnagel,1 G. Gustafson,2 I. Jaiyesimi,1 M. Folbe,2 H. Ye,1 J. Akervall,1 P. Chen,1 and D. Krauss1; 1William Beaumont Hospital, Royal Oak, MI, 2William Beaumont Hospital, Troy, MI
Volume 84 Number 3S Supplement 2012 Materials/Methods: We retrospectively studied 46 patients with OPSCC treated with CRT and who prospectively underwent baseline and posttreatment videofluoroscopic swallowing studies (VFSS) from 2007-2010. Amongst these patients, patients with identified laryngeal penetration and/or aspiration (PAS) served as the study population and patients without any identified VFSS complications served as the control cohort. Individual suprahyoid muscles were identified on the planning CT based on anatomic landmarks provided by an expert otolaryngologist (EM). This process was validated with two independent investigators. The GH, MH, AD, and HG muscle groups were collectively referred to as the floor of mouth muscles (FoM). After contouring these structures, the treatment plan for each patient was recalculated to obtain specific doses and dose volumes to these muscle groups. Comparative analysis was performed with the non-parametric Mann-Whitney test. Logistic regression analysis was used to identify model FoM dosimetric factors that may be predictive for an abnormal VFS. Results: Significant differences in the minimum, maximum, mean, median, and various volumetric doses were identified between patients with normal and abnormal VFSS PAS. Logistic regression identified the FoM V45 to be predictive of an abnormal VFS (p Z 0.026). Conclusions: The data suggests that the dose and volume delivered to the collective FoM muscles may be associated with an increased risk of VFSS identified laryngeal penetration and aspiration. Further prospective evaluation of the doses delivered to these muscles is warranted to characterize the dose-volume relationship for injury. Author Disclosure: R. Kumar: None. H. Starmer: None. S. Alcorn: None. E. Murano: None. Y. Le: None. H. Quon: None.
1104 Multinational Survey on Delivery of Radiation Therapy for Nasopharyngeal Carcinoma J.J. Lu,1 J. Cheng,2 J. Pan,3 S. Lin,3 Z. Qi,4 Y. Sun,4 J. Yi,5 L. Gao,6 N. Cheng,7 I.W. Tham1, et al.; 1National University Cancer Institute, Singapore (NCIS), Singapore, Singapore, 2National Taiwan University Hospital, Taipei, Taiwan, 3Fujian Provincial Tumor Hospital, Fuzhou, Fujian, China, 4Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China, 5Cancer Hospital of the Chinese Academy of Science, Beijing, China, 6Cancer Hospital of the Chinese Academy of Science, Beijing, China, 7West China Hospital of Sichuan University, Chengdu, Sichuan, China Purpose/Objective(s): Advanced radiation therapy techniques play a critical role in the treatment of nasopharyngeal cancer (NPC). However, optimal utilization of technology has not been determined. There is significant variation of practice between centers. We established a consortium of tertiary teaching hospitals in the endemic region of NPC across East and Southeast Asia, to prospectively collect data and initiate large studies for this disease. Materials/Methods: We collated information from 7 centers in Singapore, Mainland China, Taiwan and Hong Kong to survey the current standard of care for NPC. Six institutions completed a questionnaire with 91 items concerning pre-treatment, simulation, planning, and radiation therapy delivery characteristics. Results: All centers treat 1,800-5,900 patients annually, have 4 treatment machines each, and have site sub-specialized radiation oncologists. Each center treats 110-2,500 NPC patients annually, with a total of 3,900 new cases per year for the consortium. Close agreement was observed in many aspects of care. All centers perform MRI of the head and neck and systemic staging prior to definitive treatment. All use neoadjuvant chemotherapy for locally advanced disease, especially T4 or N3 patients. All stage III/IV patients also receive concurrent cisplatin chemotherapy, either weekly or three-weekly. Four sites use intensity modulation radiation therapy (IMRT) to treat all NPC patients; the other two use IMRT in 75-80% of patients. All start RT within 2 weeks of simulation. All treat with 2 dose levels using the simultaneous integrated boost technique, with 70 Gy in 33 fractions being the most common fractionation. Significant differences in practice were also observed. Half the centers routinely monitor blood Epstein-Barr viral deoxyribonucleic acid levels. Three centers routinely offer adjuvant
chemotherapy. Only one site would routinely offer concurrent chemotherapy for all stage II patients; the others would select patients with N1 disease, or large primary or nodal disease. Two sites would routinely fuse MRI to computed tomography (CT) simulation images. Three sites would almost never use LINAC-based rotational therapy for NPC; the others use it for <50% of their cases. Half the centers define CTV60 Gy using gross disease with an expansion; the other half would also include protocolized anatomical structures. In the five centers with CT-based image-guidance LINACs, one would perform scans daily, two would perform them weekly, and two would perform them on days 1 to 3 or 4, then weekly thereafter. Three centers have a patient-specific quality assurance. Conclusions: This survey highlights many similarities in care for NPC, and identifies “grey areas” where practices are different across centers. These divergent views will form the basis for future prospective studies to identify the standard of care for NPC. Author Disclosure: J.J. Lu: E. Research Grant; Research supported, in part, by Elekta. J. Cheng: None. J. Pan: None. S. Lin: None. Z. Qi: None. Y. Sun: None. J. Yi: None. L. Gao: None. N. Cheng: None. I.W. Tham: None.
1105 Phase II Trial of Docetaxel and Cisplatin Neoadjuvant Chemotherapy Followed by Intensity Modulated Radiation Therapy With Concurrent Cisplatin in Advanced Nasopharyngeal Carcinoma Y. Zhong, Y. Zhou, C. Xie, X. Wang, F. Zhou, and G. Chen; Wuhan University Zhongnan Hospital, Wuhan, China Purpose/Objective(s): This study aimed to evaluate the feasibility and efficacy of docetaxel and cisplatin neoadjuvant chemotherapy followed by intensity modulated radiation therapy (IMRT) with concurrent cisplatin in patients with locally advanced nasopharyngeal carcinoma. Materials/Methods: From June 2008 until October 2010, 46 patients diagnosed with stage III to IVB nasopharyngeal carcinoma were recruited in this phase II trial. All patients received 2 cycles of docetaxel (75 mg/m2) plus cisplatin (75 mg/m2) on day 1 every 3 weeks, followed by intensitymodulated radiation therapy (72 Gy/33F/6.5-7w) with concurrent cisplatin (75 mg/m2) every 3 weeks. Results: Among these patients, 45 patients completed both neoadjuvant chemotherapy and concurrent chemoradiation therapy. The objective complete response rates and partial response rates were 28.3%, 56.5% after neoadjuvant chemotherapy and 91.3%, 8.7% after concurrent chemoradiation therapy, respectively. The median follow-up time was 26 months (range, 12-39 months). One patients experienced regional recurrence and four patients developed distant metastasis. The 3-year overall survival rate and progression-free survival rate were 94.1% and 72.7%, respectively. Neutropenia (37.0%) and vomiting (28.3%) were the most common acute grades 3-4 toxicities during neoadjuvant chemotherapy while mucositis (30.4%), xerostomia (30.4%), skin (21.7%) were the most common grades 3-4 toxicities during concurrent chemoradiation therapy. Xerostomia (73.9%), dysphagia (56.5%), hear loss (30.4%) and skin (21.7%) were the common late grade 1-2 radiation toxicities. There were no grades 3-4 late radiation toxicity. Conclusions: Neoadjuvant docetaxel-cisplatin followed by IMRT with concurrent cisplatin was well feasible and effective in treating local advanced nasopharyngeal carcinoma. Further investigation to test this strategy is warranted. Author Disclosure: Y. Zhong: None. Y. Zhou: None. C. Xie: None. X. Wang: None. F. Zhou: None. G. Chen: None.
1106 A Matched Pair Comparison of Intensity Modulated Radiation Therapy With Cetuximab Versus Intensity Modulated Radiation Therapy With Platinum-based Chemotherapy for Locally Advanced Head-and-Neck Cancer J. Huang,1 A. Baschnagel,1 G. Gustafson,2 I. Jaiyesimi,1 M. Folbe,2 H. Ye,1 J. Akervall,1 P. Chen,1 and D. Krauss1; 1William Beaumont Hospital, Royal Oak, MI, 2William Beaumont Hospital, Troy, MI