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Predictors of Post-treatment Dysphagia in a Cohort of Patients with Head and Neck Cancer
Abstracts / Clinical Oncology 23 (2011) S1eS58 cancer (DTC). A prior audit (2004e2006) found that stimulated thyroglobulin (sTg) >10 mcg/l was predictive for I131 therapy (tWBS). This audit re-evaluates sTg levels at I131 ablation to select patients for I131. Methods: One hundred and six consecutive patients underwent I131 ablation for DTC (June 2006eMay 2009) with WBS and sTg measurement. Patients at low risk (based on age, sex, stage and sTg <10) had a dWBS and patients with sTG >10 high risk factors had therapy I131 with tWBS. Results: Twenty-eight patients were excluded from the analysis [negative scan and sTg (five), missing sTg (eight), Tg antibodies (two), recurrence, lost to followup, comorbidity (13)]. Fifty patients (64%) had dWBS and 28 patients (36%) received therapy I131. Forty-nine of 50 patients (98%) who had dWBS were negative, six (12%) had a sTG > 2, of which four (8%) were > 10. Twenty of 28 patients (71%) who had therapy I131 had a positive tWBS detectable sTg. Of 11 patients with sTg of >50 at ablation, 10 had a positive tWBS and sTg > 2. Eight (29%) patients had negative tWBS and sTg < 2 at the time of therapy (three had sTg < 0.5, two had sTg < 10 and three had sTg <50 at ablation). Conclusions: Ninety-eight per cent of patients with sTG < 10 at ablation had negative dWBS and this investigation could be omitted for these patients. Patients with sTg > 50 mcg/l should proceed to I131 therapy. Patients with sTg >10 e <50 mcg/l should be considered for a dWBS to guide treatment.
P5 Predictors of Post-treatment Dysphagia in a Cohort of Patients with Head and Neck Cancer K. Austin *, C. Payten y, P. Shields y, R. Simcock y * Brighton and Sussex Medical Schools, Brighton, UK y Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Introduction: Radiotherapy used in the radical and adjuvant treatment of head and neck cancers may cause long term swallowing difficulties due to radiotherapy damage to swallowing structures. A predictive score based on a cohort of patients treated in the Netherlands has been previously published [1]. A score of 9 or below indicates a low risk of swallow dysfunction and 19 and above a high risk. A useful tool may allow limited speech and language resources to be directed at a cohort of patients most likely to experience swallow dysfunction. This score was tested against a consecutive cohort of patients treated at a UK cancer centre. Methods: The medical notes, radiotherapy details and follow-up data on patients treated with radical radiotherapy for head and neck cancer for the 12 months from December 2008 were identified and reviewed. All patients had swallowing musculature included in the radiotherapy field. Swallowing outcomes had been prospectively recorded. All patients meeting the inclusion criteria of the Netherlands study were selected and a score calculated. Results: Of 216 patients, 41 met the inclusion criteria and were alive without disease at follow-up. Of these 60% had no swallowing dysfunction posttreatment. Data were complete to allow risk score calculation in 40. Scores ranged from 0 to 32 (mean 15.9, median 17.5). In the low risk score group, 4/ 15 patients (27%) had some swallow dysfunction. In the moderate risk group, 3/7 (43%), and in the high risk score group 9/18 (50%). Conclusion: The Netherlands scoring system provided a weak correlation with the risk of swallow dysfunction. The score was not a strong enough predictor in this patient group to identify the patients most likely to gain from more intensive support. Reference [1] Langendijk JA, et al. A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 2009;90 (2):189e195.
P6 Can the Introduction of a New CT Scanning Protocol Reduce Rectal Distension in Patients Prior to Radical Prostate Radiotherapy? C. Baldry, S. Knight, Y. Rimmer Department of Oncology, Addenbrooke's Hospital, Cambridge, UK Introduction: A CT scanning protocol for radical prostate radiotherapy has been introduced, comprising diet and lifestyle advice for patients, and a rescan schedule dependent on rectal diameter. We aim to assess the effectiveness of this intervention.
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Methods: Between July 2009 and August 2010 patients were asked to avoid higher fibre foods and carbonated drinks, maintain fluid intake and exercise regularly for 1 week prior to planning CT and throughout radiotherapy. Patients with a maximum rectal diameter of 5 cm were rescanned after attempting to open their bowels. If unsuccessful, dietary advice was reiterated and laxatives started prior to a rescan after a minimum of 3 days. Results: In total, 390 patients were scanned: 367 were evaluable. Two hundred and twenty (60%) followed the diet (D) for 5 days or more, and 147 (40%) did not (ND). In the D group, mean rectal diameter was 3.8 cm (range 1.7e8.0, SD 1.1) versus the ND group, mean 4.2 cm (range 2e6.4, SD 0.9), P ¼ 0.001. The number of patients with a rectal diameter 5 cm was 56: 31 (14%) in the D group versus 25 (17%) in the ND group. Rescan data were available for 37/56. Twenty-two opened their bowels the same day with a resulting mean rectal diameter of 3.7 cm, a mean reduction of 1.9 cm. Fifteen returned after further diet or laxatives, with a mean diameter of 4.6 cm. Five (33%) still had a rectal diameter of 5 cm. Conclusion: This study highlights the difficulties of achieving high patient compliance with a lifestyle intervention. There was a statistically significant difference in rectal distension between the D and ND groups at initial scan. The protocol for same day rescanning was successful with 86% (19/22) achieving a diameter of <5 cm at this time. It is apparent that some patients will continue to have significant rectal distension despite further dietary and/ or laxative intervention.
P7 Does Stopping the 12 Gy in Two Fractions Radiotherapy Regimen for the Palliative Treatment of Brain Metastases Improve Outcome? Audit of a Change in Practice in a Single UK Cancer Centre N. Bayman *, N. Dixon y, R. Swindell z * Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK y Manchester University Medical School, Manchester, UK z Department of Medical Statistics, The Christie NHS Foundation Trust, Manchester, UK Introduction: The Royal College of Radiologists consensus statement recommends dose/fractionation regimens of 30 Gy in 10 fractions, 20 Gy in five fractions and 12 Gy in two fractions, reserving the longer fractionation for patients with a better prognosis. The Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classifies patients with brain metastases into three prognostic groups (RPA IeIII, median survival 7.1e2.3 months). An audit of patients treated in 2005 at our centre demonstrated a median survival following whole brain radiotherapy (WBRT) for brain metastases of only 54 days (6 month survival 10.9%), and patients with poor prognostic factors were more likely to receive 12 Gy in two fractions. This resulted in the cessation of this regimen at this centre. This re-audit examines the effect of this change in practice on patient selection and survival after WBRT. Methods: Data were collected retrospectively from medical case notes, GP records and the cancer registry office on all patients who had undergone WBRT at a single centre during September and October 2008. Results: Of the 37 patients who were treated with WBRT for brain metastases, no patients received 12 Gy in two fractions. The median age was 65 years (40e82 years). Extracranial metastases were present in 28 (76%) patients. PS was only recorded in 13 patients. Median survival was 83 days (2.7 months) with a 6 month survival of 30.3%. Of the patients with a documented KPS, four were RPA I [median survival 212 days (7.0 months)] and seven were RPA III [median survival 43 days (1.4 months)]. Conclusions: Survival following WBRT for patients with brain metastases in this institution has improved following the cessation of the 12 Gy in two fractions regimen. However, survival remained poor in patients in the worst prognostic group. The RPA and impact of treatment toxicity on quality of life must be considered when selecting these patients for WBRT.
P8 A Timing and Quality Study of a Simple IMRT Technique for Breast Radiotherapy F. Beynon, D. Aston, T. Millin, P. Wheeler, R. Maggs, C. Goodwill Velindre Hospital, Cardiff, UK Introduction: Conventional breast planning generally involves a wedged tangential pair in which dose homogeneity can be improved by using filler
P5 Predictors of Post-treatment Dysphagia in a Cohort of Patients with Head and Neck Cancer K. Austin *, C. Payten y, P. Shields y, R. Simcock y * Brighton and Sussex Medical Schools, Brighton, UK y Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Introduction: Radiotherapy used in the radical and adjuvant treatment of head and neck cancers may cause long term swallowing difficulties due to radiotherapy damage to swallowing structures. A predictive score based on a cohort of patients treated in the Netherlands has been previously published [1]. A score of 9 or below indicates a low risk of swallow dysfunction and 19 and above a high risk. A useful tool may allow limited speech and language resources to be directed at a cohort of patients most likely to experience swallow dysfunction. This score was tested against a consecutive cohort of patients treated at a UK cancer centre. Methods: The medical notes, radiotherapy details and follow-up data on patients treated with radical radiotherapy for head and neck cancer for the 12 months from December 2008 were identified and reviewed. All patients had swallowing musculature included in the radiotherapy field. Swallowing outcomes had been prospectively recorded. All patients meeting the inclusion criteria of the Netherlands study were selected and a score calculated. Results: Of 216 patients, 41 met the inclusion criteria and were alive without disease at follow-up. Of these 60% had no swallowing dysfunction posttreatment. Data were complete to allow risk score calculation in 40. Scores ranged from 0 to 32 (mean 15.9, median 17.5). In the low risk score group, 4/ 15 patients (27%) had some swallow dysfunction. In the moderate risk group, 3/7 (43%), and in the high risk score group 9/18 (50%). Conclusion: The Netherlands scoring system provided a weak correlation with the risk of swallow dysfunction. The score was not a strong enough predictor in this patient group to identify the patients most likely to gain from more intensive support. Reference [1] Langendijk JA, et al. A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer. Radiother Oncol 2009;90 (2):189e195.
P6 Can the Introduction of a New CT Scanning Protocol Reduce Rectal Distension in Patients Prior to Radical Prostate Radiotherapy? C. Baldry, S. Knight, Y. Rimmer Department of Oncology, Addenbrooke's Hospital, Cambridge, UK Introduction: A CT scanning protocol for radical prostate radiotherapy has been introduced, comprising diet and lifestyle advice for patients, and a rescan schedule dependent on rectal diameter. We aim to assess the effectiveness of this intervention.
S29
Methods: Between July 2009 and August 2010 patients were asked to avoid higher fibre foods and carbonated drinks, maintain fluid intake and exercise regularly for 1 week prior to planning CT and throughout radiotherapy. Patients with a maximum rectal diameter of 5 cm were rescanned after attempting to open their bowels. If unsuccessful, dietary advice was reiterated and laxatives started prior to a rescan after a minimum of 3 days. Results: In total, 390 patients were scanned: 367 were evaluable. Two hundred and twenty (60%) followed the diet (D) for 5 days or more, and 147 (40%) did not (ND). In the D group, mean rectal diameter was 3.8 cm (range 1.7e8.0, SD 1.1) versus the ND group, mean 4.2 cm (range 2e6.4, SD 0.9), P ¼ 0.001. The number of patients with a rectal diameter 5 cm was 56: 31 (14%) in the D group versus 25 (17%) in the ND group. Rescan data were available for 37/56. Twenty-two opened their bowels the same day with a resulting mean rectal diameter of 3.7 cm, a mean reduction of 1.9 cm. Fifteen returned after further diet or laxatives, with a mean diameter of 4.6 cm. Five (33%) still had a rectal diameter of 5 cm. Conclusion: This study highlights the difficulties of achieving high patient compliance with a lifestyle intervention. There was a statistically significant difference in rectal distension between the D and ND groups at initial scan. The protocol for same day rescanning was successful with 86% (19/22) achieving a diameter of <5 cm at this time. It is apparent that some patients will continue to have significant rectal distension despite further dietary and/ or laxative intervention.
P7 Does Stopping the 12 Gy in Two Fractions Radiotherapy Regimen for the Palliative Treatment of Brain Metastases Improve Outcome? Audit of a Change in Practice in a Single UK Cancer Centre N. Bayman *, N. Dixon y, R. Swindell z * Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK y Manchester University Medical School, Manchester, UK z Department of Medical Statistics, The Christie NHS Foundation Trust, Manchester, UK Introduction: The Royal College of Radiologists consensus statement recommends dose/fractionation regimens of 30 Gy in 10 fractions, 20 Gy in five fractions and 12 Gy in two fractions, reserving the longer fractionation for patients with a better prognosis. The Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classifies patients with brain metastases into three prognostic groups (RPA IeIII, median survival 7.1e2.3 months). An audit of patients treated in 2005 at our centre demonstrated a median survival following whole brain radiotherapy (WBRT) for brain metastases of only 54 days (6 month survival 10.9%), and patients with poor prognostic factors were more likely to receive 12 Gy in two fractions. This resulted in the cessation of this regimen at this centre. This re-audit examines the effect of this change in practice on patient selection and survival after WBRT. Methods: Data were collected retrospectively from medical case notes, GP records and the cancer registry office on all patients who had undergone WBRT at a single centre during September and October 2008. Results: Of the 37 patients who were treated with WBRT for brain metastases, no patients received 12 Gy in two fractions. The median age was 65 years (40e82 years). Extracranial metastases were present in 28 (76%) patients. PS was only recorded in 13 patients. Median survival was 83 days (2.7 months) with a 6 month survival of 30.3%. Of the patients with a documented KPS, four were RPA I [median survival 212 days (7.0 months)] and seven were RPA III [median survival 43 days (1.4 months)]. Conclusions: Survival following WBRT for patients with brain metastases in this institution has improved following the cessation of the 12 Gy in two fractions regimen. However, survival remained poor in patients in the worst prognostic group. The RPA and impact of treatment toxicity on quality of life must be considered when selecting these patients for WBRT.
P8 A Timing and Quality Study of a Simple IMRT Technique for Breast Radiotherapy F. Beynon, D. Aston, T. Millin, P. Wheeler, R. Maggs, C. Goodwill Velindre Hospital, Cardiff, UK Introduction: Conventional breast planning generally involves a wedged tangential pair in which dose homogeneity can be improved by using filler