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Postoperative Radiation Therapy for Salivary Gland Malignancies: Risk Stratification for the Impact of Concurrent Chemotherapy
Poster Viewing Abstracts S459
Volume 87 Number 2S Supplement 2013 Poster Viewing Abstract 2670; Table
No. patients T3/4 PNI+ Positive margin Histology Acinic cell Mucoepidermoid Adenocarcinoma Other
Disease characteristics
RT
No RT
All
34 10 (29%) 11 (32%) 29 (85%)
22 2 (9%) 4 (18%) 9 (41%)
56 12 (21%) 15 (27%) 38 (68%)
11 14 6 3
(32%) (41%) (18%) (9%)
5 13 2 2
(23%) (59%) (9%) (9%)
16 27 8 5
(29%) (48%) (14%) (9%)
Conclusions: Although radiation-induced sialadenitis and fibrosis of the parotid glands are the most common and well-known etiologies of xerostomia following head-and-neck RT, they are particularly challenging to assess. This work has demonstrated the feasibility of ultrasonic evaluations of parotid sialadenitis and fibrosis. This study provides meaningful preliminary data from which both observational and interventional clinical research can be designed. Author Disclosure: X. Yang: None. J.J. Beitler: None. D.S. Yu: None. S. Tridandapani: None. D.W. Bruner: None. W.J. Curran: None. T. Liu: None.
2672 rates for local control (LC) and overall survival (OS) were calculated using the Kaplan-Meier method. Results: Median follow-up was 38.6 months (range, 0.2 to 133.7 months). Disease characteristics are presented in the Table. LC at 5-years with and without postoperative radiation therapy were 100% vs 75.8% (p Z 0.0478), respectively. Both patients who recurred did not receive radiation therapy (RT) and had T3/4 disease. One was salvaged with surgery, and the other was unresectable. OS at 5-years with and without RT was 100% vs 90% (p > 0.05), respectively. No patients died from their disease. Conclusions: For low/intermediate grade parotid gland carcinoma, patients with close/positive margins have an excellent outcome with or without postoperative radiation therapy. Radiation therapy improves local control. Author Disclosure: J. Wu: None. S. Rahman: None. S. Iganej: None. E.W. Ngor: None. J. Chen: None.
2671 Quantitative Ultrasound Evaluation of Post-Radiation Therapy Sialadenitis and Fibrosis of the Parotid Glands in Patients Following Head-and-Neck Radiation Therapy X. Yang, J.J. Beitler, D.S. Yu, S. Tridandapani, D.W. Bruner, W.J. Curran, and T. Liu; Emory University, Atlanta, GA Purpose/Objective(s): Xerostomia (dry mouth) is one of the most common side effects affecting patients following head-and-neck radiation therapy (RT). Clinically significant xerostomia is caused by myoepithelial sialadenitis and fibrosis within the parotid glands. Recent ultrasound studies have shown that healthy parotid glands tend to be homogeneous in echotexture, whereas post-RT parotid glands are heterogeneous, with multiple hypoechoic (inflammation) or hyperechoic (fibrosis) regions. This study’s purpose is to develop a novel ultrasound technique to quantitatively evaluate sialadenitis and fibrosis in post-RT parotid glands. Materials/Methods: We propose to use group-Gaussian fittings of the echo-histogram to quantitatively evaluate the presence of sialadenitis and fibrosis. A cross-sectional pilot study was conducted with 18 post-RT patients (mean age: 60.7 7.3 years, follow-up: 20.1 10.4 months) and 13 healthy-volunteer control group. Of the 18 patients, the median dose to the primary tumors was 67.8 3.8 Gy, and the mean dose to the 36 parotid glands was 36.3 11.3 Gy. All enrolled patients experienced grade 1 or 2 late salivary-gland toxicity (RTOG/EORTC morbidity scale). Each participant underwent an ultrasound scan (10 MHz) of the bilateral parotid glands. The intensity of the B-mode image ranged from 0 to 255. The echointensity histogram for each parotid was derived from the contoured parotid glands. We used group Gaussian components to fit histogram and R2 values were used to evaluate the quality of the fitting (perfect fitting: R2 Z 1.0). Results: All 26 parotid glands of healthy volunteers fitted well with one Gaussian function, with a mean intensity of 79.8 4.9 (R2 >0.96). This is expected because normal parotid glands consist entirely of serous cells. Thirty-two of the 36 post-RT parotid glands fitted well with 3 Gaussian functions, with mean intensities of 49.7 7.6, 77.2 8.7, and 118.6 11.8 (R2 >0.98). The remaining 4 post-RT parotid glands fitted well with 2 Gaussian functions, with mean intensities 74.3 4.8 and 118.5 12.4 (R2 >0.98). The Gaussian function with low intensity (hypoechoic regions) corresponds to radiation-induced chronic sialadenitis, while the Gaussian function with high intensity (hyperechoic regions) corresponds to the fibrotic changes.
Postoperative Radiation Therapy for Salivary Gland Malignancies: Risk Stratification for the Impact of Concurrent Chemotherapy C. Hsieh,1,2 C. Lin,1 N. Tsang,1 J. Chang,1 K. Fan,1 B. Huang,1 C. Liao,3 H. Wang,4 L. Lee,5 and J. Hong1,2; 1Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, 3Department of Ear, Nose, and Throat, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 4Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 5Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan Purpose/Objective(s): To investigate the potential values of concurrent chemotherapy in patients with salivary gland malignancies treated by postoperative radiation therapy (RT). Materials/Methods: This study is a retrospective review from the cancer registration database. Between January 2001 and December 2011, there were 156 consecutive patients with salivary gland malignancies treated with curative surgery followed by postoperative RT (n Z 68) or concurrent chemoradiation therapy (CCRT) (n Z 88). The primary tumorous glandular sites were 52% in parotid, 26% in submandibular, 6% in sublingual, and 16% in minor salivary glands. The median cumulative radiation doses were 66 Gy for both groups, and Cisplatin-based concurrent chemotherapy was the most commonly used regimens. The median follow-up times were 4.5 years for the entire cohort and 5.4 years for survivors. The associated patients’ characteristics, pathological factors and treatment outcomes were analyzed. Results: The 5-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) in postoperative RT and CCRT groups were 96% vs 87% (p Z 0.169), 89% vs 73% (p Z 0.070), and 87% vs 91% (p Z 0.288) for stage I and II patients, and 80% vs 83% (p Z 0.960), 58% vs 56% (p Z 0.582), and 70% vs 60% (p Z 0.470) for stage III and IV patients, respectively. Six significant adverse prognosticators including T3-4, positive nodes (N+), positive surgical margin (margin+), perineural invasion (PNI+), high-grade histology, and nodal extracapsular spreading (ECS+) were observed, and patients who underwent CCRT had higher proportions of adverse prognosticators. We stratified patients into low (0-2 risks), intermediate (3-4 risks), and high risk (5-6 risks) groups, and the 5year LRC, DFS, and OS were not significantly different between RT and CCRT arms in all of the 3 risk groups. However, in selected cases with adenoid cystic carcinoma or lymphoepithelial carcinoma, CCRT improved 5-year LRC for those in combination with margin+ (p Z 0.048), PNI+ (p Z 0.036), or with more than 3 risk factors (p Z 0.026). Conclusions: In the present study, addition of concurrent chemotherapy to postoperative RT might not effectively improve treatment outcomes, except in selected high risk patients with adenoid cystic carcinoma or lymphoepithelial carcinoma. Author Disclosure: C. Hsieh: None. C. Lin: None. N. Tsang: None. J. Chang: None. K. Fan: None. B. Huang: None. C. Liao: None. H. Wang: None. L. Lee: None. J. Hong: None.
2673 Adaptive Treatment Planning With F-18 FDG-PET and CT Scans to Optimize Parotid Sparing in Head-and-Neck Cancer A. Kim, S. Das, R. Kingshuk, K. Temple, D. Yoo, and D.M. Brizel; Duke Cancer Institute, Durham, NC
Volume 87 Number 2S Supplement 2013 Poster Viewing Abstract 2670; Table
No. patients T3/4 PNI+ Positive margin Histology Acinic cell Mucoepidermoid Adenocarcinoma Other
Disease characteristics
RT
No RT
All
34 10 (29%) 11 (32%) 29 (85%)
22 2 (9%) 4 (18%) 9 (41%)
56 12 (21%) 15 (27%) 38 (68%)
11 14 6 3
(32%) (41%) (18%) (9%)
5 13 2 2
(23%) (59%) (9%) (9%)
16 27 8 5
(29%) (48%) (14%) (9%)
Conclusions: Although radiation-induced sialadenitis and fibrosis of the parotid glands are the most common and well-known etiologies of xerostomia following head-and-neck RT, they are particularly challenging to assess. This work has demonstrated the feasibility of ultrasonic evaluations of parotid sialadenitis and fibrosis. This study provides meaningful preliminary data from which both observational and interventional clinical research can be designed. Author Disclosure: X. Yang: None. J.J. Beitler: None. D.S. Yu: None. S. Tridandapani: None. D.W. Bruner: None. W.J. Curran: None. T. Liu: None.
2672 rates for local control (LC) and overall survival (OS) were calculated using the Kaplan-Meier method. Results: Median follow-up was 38.6 months (range, 0.2 to 133.7 months). Disease characteristics are presented in the Table. LC at 5-years with and without postoperative radiation therapy were 100% vs 75.8% (p Z 0.0478), respectively. Both patients who recurred did not receive radiation therapy (RT) and had T3/4 disease. One was salvaged with surgery, and the other was unresectable. OS at 5-years with and without RT was 100% vs 90% (p > 0.05), respectively. No patients died from their disease. Conclusions: For low/intermediate grade parotid gland carcinoma, patients with close/positive margins have an excellent outcome with or without postoperative radiation therapy. Radiation therapy improves local control. Author Disclosure: J. Wu: None. S. Rahman: None. S. Iganej: None. E.W. Ngor: None. J. Chen: None.
2671 Quantitative Ultrasound Evaluation of Post-Radiation Therapy Sialadenitis and Fibrosis of the Parotid Glands in Patients Following Head-and-Neck Radiation Therapy X. Yang, J.J. Beitler, D.S. Yu, S. Tridandapani, D.W. Bruner, W.J. Curran, and T. Liu; Emory University, Atlanta, GA Purpose/Objective(s): Xerostomia (dry mouth) is one of the most common side effects affecting patients following head-and-neck radiation therapy (RT). Clinically significant xerostomia is caused by myoepithelial sialadenitis and fibrosis within the parotid glands. Recent ultrasound studies have shown that healthy parotid glands tend to be homogeneous in echotexture, whereas post-RT parotid glands are heterogeneous, with multiple hypoechoic (inflammation) or hyperechoic (fibrosis) regions. This study’s purpose is to develop a novel ultrasound technique to quantitatively evaluate sialadenitis and fibrosis in post-RT parotid glands. Materials/Methods: We propose to use group-Gaussian fittings of the echo-histogram to quantitatively evaluate the presence of sialadenitis and fibrosis. A cross-sectional pilot study was conducted with 18 post-RT patients (mean age: 60.7 7.3 years, follow-up: 20.1 10.4 months) and 13 healthy-volunteer control group. Of the 18 patients, the median dose to the primary tumors was 67.8 3.8 Gy, and the mean dose to the 36 parotid glands was 36.3 11.3 Gy. All enrolled patients experienced grade 1 or 2 late salivary-gland toxicity (RTOG/EORTC morbidity scale). Each participant underwent an ultrasound scan (10 MHz) of the bilateral parotid glands. The intensity of the B-mode image ranged from 0 to 255. The echointensity histogram for each parotid was derived from the contoured parotid glands. We used group Gaussian components to fit histogram and R2 values were used to evaluate the quality of the fitting (perfect fitting: R2 Z 1.0). Results: All 26 parotid glands of healthy volunteers fitted well with one Gaussian function, with a mean intensity of 79.8 4.9 (R2 >0.96). This is expected because normal parotid glands consist entirely of serous cells. Thirty-two of the 36 post-RT parotid glands fitted well with 3 Gaussian functions, with mean intensities of 49.7 7.6, 77.2 8.7, and 118.6 11.8 (R2 >0.98). The remaining 4 post-RT parotid glands fitted well with 2 Gaussian functions, with mean intensities 74.3 4.8 and 118.5 12.4 (R2 >0.98). The Gaussian function with low intensity (hypoechoic regions) corresponds to radiation-induced chronic sialadenitis, while the Gaussian function with high intensity (hyperechoic regions) corresponds to the fibrotic changes.
Postoperative Radiation Therapy for Salivary Gland Malignancies: Risk Stratification for the Impact of Concurrent Chemotherapy C. Hsieh,1,2 C. Lin,1 N. Tsang,1 J. Chang,1 K. Fan,1 B. Huang,1 C. Liao,3 H. Wang,4 L. Lee,5 and J. Hong1,2; 1Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, 3Department of Ear, Nose, and Throat, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 4Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, 5Department of Pathology, Chang Gung Memorial Hospital, Taoyuan, Taiwan Purpose/Objective(s): To investigate the potential values of concurrent chemotherapy in patients with salivary gland malignancies treated by postoperative radiation therapy (RT). Materials/Methods: This study is a retrospective review from the cancer registration database. Between January 2001 and December 2011, there were 156 consecutive patients with salivary gland malignancies treated with curative surgery followed by postoperative RT (n Z 68) or concurrent chemoradiation therapy (CCRT) (n Z 88). The primary tumorous glandular sites were 52% in parotid, 26% in submandibular, 6% in sublingual, and 16% in minor salivary glands. The median cumulative radiation doses were 66 Gy for both groups, and Cisplatin-based concurrent chemotherapy was the most commonly used regimens. The median follow-up times were 4.5 years for the entire cohort and 5.4 years for survivors. The associated patients’ characteristics, pathological factors and treatment outcomes were analyzed. Results: The 5-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) in postoperative RT and CCRT groups were 96% vs 87% (p Z 0.169), 89% vs 73% (p Z 0.070), and 87% vs 91% (p Z 0.288) for stage I and II patients, and 80% vs 83% (p Z 0.960), 58% vs 56% (p Z 0.582), and 70% vs 60% (p Z 0.470) for stage III and IV patients, respectively. Six significant adverse prognosticators including T3-4, positive nodes (N+), positive surgical margin (margin+), perineural invasion (PNI+), high-grade histology, and nodal extracapsular spreading (ECS+) were observed, and patients who underwent CCRT had higher proportions of adverse prognosticators. We stratified patients into low (0-2 risks), intermediate (3-4 risks), and high risk (5-6 risks) groups, and the 5year LRC, DFS, and OS were not significantly different between RT and CCRT arms in all of the 3 risk groups. However, in selected cases with adenoid cystic carcinoma or lymphoepithelial carcinoma, CCRT improved 5-year LRC for those in combination with margin+ (p Z 0.048), PNI+ (p Z 0.036), or with more than 3 risk factors (p Z 0.026). Conclusions: In the present study, addition of concurrent chemotherapy to postoperative RT might not effectively improve treatment outcomes, except in selected high risk patients with adenoid cystic carcinoma or lymphoepithelial carcinoma. Author Disclosure: C. Hsieh: None. C. Lin: None. N. Tsang: None. J. Chang: None. K. Fan: None. B. Huang: None. C. Liao: None. H. Wang: None. L. Lee: None. J. Hong: None.
2673 Adaptive Treatment Planning With F-18 FDG-PET and CT Scans to Optimize Parotid Sparing in Head-and-Neck Cancer A. Kim, S. Das, R. Kingshuk, K. Temple, D. Yoo, and D.M. Brizel; Duke Cancer Institute, Durham, NC