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Pretreatment F-18 Fluorodeoxyglucose-positron Emission Tomography Standardized Uptake Value Predicts Survival After Radiation Therapy in Nasopharyngeal Carcinoma
I. J. Radiation Oncology d Biology d Physics
S442
Volume 69, Number 3, Supplement, 2007
Author Disclosure: A. Goenka, None; J. Zhou, None; S. Rudra, None; R. Garg, None; T. Farrag, None; W. Koch, None; J. Califano, None; A. Forastiere, None; R.P. Tufano, None; G.K. Bajaj, None.
2430
Comparison of Stereotactic Radiosurgery and Radiotherapy in Salvaging Local Failures of Nasopharyngeal Carcinoma
D. Chua1, S. Wu2, J. Sham1, G. Au1 1
Queen Mary Hospital, Pokfulam, Hong Kong, 2Cancer Center, Sun Yat-Sen University, Guangzhou, China
Purpose/Objective(s): Local failure is an important cause of treatment failure in nasopharyngeal carcinoma (NPC). Although surgery and brachytherapy can be used as salvage treatment in selected cases, most patients with local failure of NPC require external reirradiation. Both stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been employed in reirradiation of NPC, but the relative efficacy of these two techniques is not known. Patients/Methods: Records of 125 NPC patients who received SRS or SRT in two centers were reviewed. Patients who received treatment as a planned boost after external radiotherapy and those with disease elsewhere were excluded. A matched-pair study was used to select and analyze the outcome of patients. A total of 86 patients were included in the study, with equal number of patients treated by SRS and SRT. All patients were individually matched for type of failure (persistent if #6 months of 1st radiotherapy vs. recurrent if .6 months), retreatment T stage (rT1-2 vs. rT3-4), and tumor volume (#5 cc vs. .5–10 cc vs. .10 cc). Median dose was 12.5 Gy in single fraction by SRS, and 34 Gy in 2–6 fractions by SRT. Median follow-up was 34 months for SRS group and 18 months for SRT group. Results: Local control was better in patients treated by SRT, but there was no significant difference in overall survival. One- and 3year local failure-free rates were 70% and 51% in SRS group compared with 91% and 83% in SRT group (p = 0.003). One- and 3year overall survival rates were 98% and 66% in SRS group compared with 78% and 61% in SRT group (p = 0.31). The differences in local control were mainly observed in patients treated for recurrent or rT2-4 disease, with no significant differences in local control using either technique in persistent or rT1 disease. Severe late complications occurred in 33% of patients in SRS group and 21% in SRT group, including brain necrosis (16% vs. 7%), brain stem necrosis (0 vs. 5%), mucosal necrosis (0 vs. 12%), and hemorrhage (5% vs. 2%). Conclusions: This retrospective study showed that SRT was superior to SRS in salvaging local failures of NPC, especially in patients with recurrent and rT2-4 disease. In patients with local failure of NPC, SRT may be the preferred technique of reirradiation compared with SRS. Author Disclosure: D. Chua, None; S. Wu, None; J. Sham, None; G. Au, None.
2431
Pretreatment F-18 Fluorodeoxyglucose-positron Emission Tomography Standardized Uptake Value Predicts Survival After Radiation Therapy in Nasopharyngeal Carcinoma
X. Meng1, J. Yu1, S. Liu2, J. Li2, Z. Fu1, X. Sun1, G. Yang1, L. Kong1, A. Han1 1
Shandong Cancer Hospital and Institute, Jinan, China, 2Wanjie Hospital, Zibo, China
Purpose/Objective(s): To determine whether the standardized uptake value (SUV) of F-18 fluorodeoxyglucose uptake by positron emission tomography could be a prognostic factor for nasopharyngeal carcinoma (NPC). Materials/Methods: One hundred and two patients (86 men, 16 women) with stage I to stage Z NPC were retrospectively reviewed. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and local-regional control (LRC) were estimated by the method of Kaplan and Meier. The log-rank test was used to assess the equality of the survivor function across groups. Results: The follow-up evaluation was completed and closed out on May 31, 2006. Median follow-up for surviving patients was 38 months (range, 29 to 48 months). A cutoff 7 for the SUV for the primary tumor showed the best discriminative value. The 3-year OS rate was 86 percent. When examined by SUV for primary tumor, the 3-year OS rate in the 30 patients with low SUVmax (#7.0) was significantly better than that of the 72 patients with high SUVmax (.7.0; 3-year OS, 93 percent vs 75 percent; p = 0.02).
Proceedings of the 49th Annual ASTRO Meeting Patients with low SUVmax (#7.0) showed significantly better DFS rates than those with high SUVmax (.7.0) (3-year DFS, 79 percent vs 60 percent; p = 0.03). The LRC and DMFS rates were then independently evaluated to clarify the pattern of relapse. In this analysis as well, patients with low SUVs showed better tumor control from the standpoint of both the LRC rate and the DMFS rate (3-year LRC rate: 91 percent vs 70 percent, p = 0.01; 3-year DMFS rate: 89 percent vs 52 percent, p = 0.009). Next, to confirm the discriminatory ability of the cutoff SUV of 7, the DFS by stage of disease (stage I or II [early] vs stage IIIa or IIIb [advanced]) was assessed. Interestingly, in both stage subgroups, patients with low SUVs showed a significantly better 3-year DFS rate than those with high SUVs (stage I or II, 86 percent vs 67 percent, p = 0.01; stage IIIa or IIIb, 74 percent vs 51 percent; p = 0.004). Uptake in squamous cell carcinomas was not different from undifferentiated carcinoma (t = 2.75, p = 0.79). The median SUVmax of the squamous cell carcinomas (n = 71) was 7.7 ± 4.4 and the median SUVmax of the undifferentiated carcinoma (n = 31) was 10.9 ± 8.6. However, uptake in patients with pathologic nodal involvement was higher than in those patients who were N0. The mean SUVmax in N0 patients (n = 20) was 8.9 ± 6.3 and the mean SUVmax in N1-2 patients (n = 82) was 13.6 ± 6.9 (p = 0.02). Uptake in no complete remission (NCR) tended to be higher than in complete remission(CR); The median SUVmax of the NCR (n = 44) was 13.3 ± 6.4 and the median SUVmax of the CR (n = 58) was 8.6 ± 6.0 (p = 0.04). Conclusions: The SUVof the primary tumor was one of the important prognostic factors among the patients treated by radical radiotherapy. Author Disclosure: X. Meng, None; J. Yu, None; S. Liu, None; J. Li, None; Z. Fu, None; X. Sun, None; G. Yang, None; L. Kong, None; A. Han, None.
2432
Relapse Patterns and Related Prognostic Factors in Mobile Tongue Cancer Treated by Postoperative Adjuvant Radiotherapy
S. Kamer1, M. Esassolak2, S. Demirci1, A. Sengul1, A. Yavuzer3 1 Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey, 2Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey, 3Ege University Faculty of Medicine, Department of Otolarynogology, Izmir, Turkey
Purpose/Objective(s): Squamous cell carcinoma of oral cavity has a worse outcome among head and neck cancers, and the mobile tongue is the most affected site in the oral cavity. The aim of this study is to define relapse patterns and related prognostic factors in mobile tongue cancer treated by postoperative adjuvant radiotherapy. Materials/Methods: Sixty-six consecutive patients with squamous cell carcinoma of mobile tongue who received postoperative radiotherapy between January 1995 and December 2005 were analyzed retrospectively. The extent of surgical resection was determined by the intraoperative findings with the intent being to resect all disease with negative margins if possible. The indication for bilateral neck dissections was palpable adenopathy at presentation. Surgical resection consisted of partial glossectomy alone in 4 patients. Fifty three patients underwent unilateral and 9 patients underwent bilateral neck dissection. Radiotherapy was delivered using with the shrinking field technique and initial portal was designed using standard three-field technique to cover surgical bed and the areas at risk containing nodal disease. Median radiation dose was 6000 cGy (range: 5400–6600 cGy) and first field reduction excluded the spinal cord after 46 Gy. Postoperative radiotherapy was planned to patients with one or more of the following risk factors at final pathology: advanced T stage; margins of resection positive or ‘‘close’’ (defined as tumor within 5 mm from resection edge); invasion of lymphatics and/or blood vessels; perineural invasion; more than one involved lymph node; single node larger than 3 cm; or extracapsular extension on at least one node. Based on postoperative staging; pathologic T stage was as follows: 19% T1, 53% T2, 14% T3, and 14% T4. Results: With a median follow-up for surviving patients of 74 months 5 year disease free, locoregional failure free and cause spesific survival rates were 44%, 46% and 53% respectively. During the analyze locoregional failure was detected in 28 patients. Nineteen of the recurrences were in the primary tumor region, five of them were in the neck, 4 of them were in both. Most of the local failures were experienced in first year (median: 13 months, range: 5–15 months). There were 4 patients that failed distantly; 2 had lung metastasis, 2 had bone metastasis. According to univariate analysis, locoregional control is strongly correlated with surgical margin (p = 0.03), tumor localization (p = 0.00), T stage (p = 0.00), stage (p = 0.00), initial hemoglobine (Hb) level (p = 0.00) and gender (p = 0.04). Total of 36 deaths had occurred: 29 patients had died from progressive disease (range: 7 to 132 months). One patient died from due to second primary tumor (esophageal cancer) and six patients died from the other causes. A significantly higher 5-year overall survival rate was observed among patients with tumors located in lateral side of the tongue compared to those with midline located tumor (72% vs. 25%; p = 0.00), and in those with Hb level .12 g/dl compared to those with a lower Hb level (68% vs. 32%; p = 0.01). Surgical margin status, stage of the disease (p = 0.01) and T stage had also an adverse effect on overall survival (p \ 0.01). Conclusions: Most of the failures were experienced in the primary tumor area. Close follow-up is strongly recommended for these patients especially in two years. Author Disclosure: S. Kamer, None; M. Esassolak, None; S. Demirci, None; A. Sengul, None; A. Yavuzer, None.
2433
The Effect of an Aggressive Enteral Nutritional Program on Daily Setup Variations and Planning Margins of Head and Neck Cancer Patients
A. L. Mercuri1, M. Wada1, A. Rolfo2, D. Lim Joon1, C. A. Mantle1, K. Kaegi1, M. Feigen1, V. Khoo3 1
Austin Health Radiation Oncology Centre, Melbourne VIC, Australia, 2Peter MacCallum Cancer Institute, Melbourne VIC, Australia, 3Royal Marsden Hospital, Department of Radiation Oncology, Sutton Surrey, United Kingdom Purpose/Objective(s): During a course of curative head and neck (H&N) radiotherapy, impacts of response, in terms of tumour regression and possible weight loss, are apparent. Such response plays a factor in altering geometry and possibly radiation dosimetry, leading to potential geometrical target miss and over dosage of organs at risk. At Austin Health, we have a policy of routine pre-treatment nutritional assessment, management and enteral feeding program through the use of the percutaneous endoscopic gastrostomy (PEG) tube for selected cases.
S443
S442
Volume 69, Number 3, Supplement, 2007
Author Disclosure: A. Goenka, None; J. Zhou, None; S. Rudra, None; R. Garg, None; T. Farrag, None; W. Koch, None; J. Califano, None; A. Forastiere, None; R.P. Tufano, None; G.K. Bajaj, None.
2430
Comparison of Stereotactic Radiosurgery and Radiotherapy in Salvaging Local Failures of Nasopharyngeal Carcinoma
D. Chua1, S. Wu2, J. Sham1, G. Au1 1
Queen Mary Hospital, Pokfulam, Hong Kong, 2Cancer Center, Sun Yat-Sen University, Guangzhou, China
Purpose/Objective(s): Local failure is an important cause of treatment failure in nasopharyngeal carcinoma (NPC). Although surgery and brachytherapy can be used as salvage treatment in selected cases, most patients with local failure of NPC require external reirradiation. Both stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) have been employed in reirradiation of NPC, but the relative efficacy of these two techniques is not known. Patients/Methods: Records of 125 NPC patients who received SRS or SRT in two centers were reviewed. Patients who received treatment as a planned boost after external radiotherapy and those with disease elsewhere were excluded. A matched-pair study was used to select and analyze the outcome of patients. A total of 86 patients were included in the study, with equal number of patients treated by SRS and SRT. All patients were individually matched for type of failure (persistent if #6 months of 1st radiotherapy vs. recurrent if .6 months), retreatment T stage (rT1-2 vs. rT3-4), and tumor volume (#5 cc vs. .5–10 cc vs. .10 cc). Median dose was 12.5 Gy in single fraction by SRS, and 34 Gy in 2–6 fractions by SRT. Median follow-up was 34 months for SRS group and 18 months for SRT group. Results: Local control was better in patients treated by SRT, but there was no significant difference in overall survival. One- and 3year local failure-free rates were 70% and 51% in SRS group compared with 91% and 83% in SRT group (p = 0.003). One- and 3year overall survival rates were 98% and 66% in SRS group compared with 78% and 61% in SRT group (p = 0.31). The differences in local control were mainly observed in patients treated for recurrent or rT2-4 disease, with no significant differences in local control using either technique in persistent or rT1 disease. Severe late complications occurred in 33% of patients in SRS group and 21% in SRT group, including brain necrosis (16% vs. 7%), brain stem necrosis (0 vs. 5%), mucosal necrosis (0 vs. 12%), and hemorrhage (5% vs. 2%). Conclusions: This retrospective study showed that SRT was superior to SRS in salvaging local failures of NPC, especially in patients with recurrent and rT2-4 disease. In patients with local failure of NPC, SRT may be the preferred technique of reirradiation compared with SRS. Author Disclosure: D. Chua, None; S. Wu, None; J. Sham, None; G. Au, None.
2431
Pretreatment F-18 Fluorodeoxyglucose-positron Emission Tomography Standardized Uptake Value Predicts Survival After Radiation Therapy in Nasopharyngeal Carcinoma
X. Meng1, J. Yu1, S. Liu2, J. Li2, Z. Fu1, X. Sun1, G. Yang1, L. Kong1, A. Han1 1
Shandong Cancer Hospital and Institute, Jinan, China, 2Wanjie Hospital, Zibo, China
Purpose/Objective(s): To determine whether the standardized uptake value (SUV) of F-18 fluorodeoxyglucose uptake by positron emission tomography could be a prognostic factor for nasopharyngeal carcinoma (NPC). Materials/Methods: One hundred and two patients (86 men, 16 women) with stage I to stage Z NPC were retrospectively reviewed. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) and local-regional control (LRC) were estimated by the method of Kaplan and Meier. The log-rank test was used to assess the equality of the survivor function across groups. Results: The follow-up evaluation was completed and closed out on May 31, 2006. Median follow-up for surviving patients was 38 months (range, 29 to 48 months). A cutoff 7 for the SUV for the primary tumor showed the best discriminative value. The 3-year OS rate was 86 percent. When examined by SUV for primary tumor, the 3-year OS rate in the 30 patients with low SUVmax (#7.0) was significantly better than that of the 72 patients with high SUVmax (.7.0; 3-year OS, 93 percent vs 75 percent; p = 0.02).
Proceedings of the 49th Annual ASTRO Meeting Patients with low SUVmax (#7.0) showed significantly better DFS rates than those with high SUVmax (.7.0) (3-year DFS, 79 percent vs 60 percent; p = 0.03). The LRC and DMFS rates were then independently evaluated to clarify the pattern of relapse. In this analysis as well, patients with low SUVs showed better tumor control from the standpoint of both the LRC rate and the DMFS rate (3-year LRC rate: 91 percent vs 70 percent, p = 0.01; 3-year DMFS rate: 89 percent vs 52 percent, p = 0.009). Next, to confirm the discriminatory ability of the cutoff SUV of 7, the DFS by stage of disease (stage I or II [early] vs stage IIIa or IIIb [advanced]) was assessed. Interestingly, in both stage subgroups, patients with low SUVs showed a significantly better 3-year DFS rate than those with high SUVs (stage I or II, 86 percent vs 67 percent, p = 0.01; stage IIIa or IIIb, 74 percent vs 51 percent; p = 0.004). Uptake in squamous cell carcinomas was not different from undifferentiated carcinoma (t = 2.75, p = 0.79). The median SUVmax of the squamous cell carcinomas (n = 71) was 7.7 ± 4.4 and the median SUVmax of the undifferentiated carcinoma (n = 31) was 10.9 ± 8.6. However, uptake in patients with pathologic nodal involvement was higher than in those patients who were N0. The mean SUVmax in N0 patients (n = 20) was 8.9 ± 6.3 and the mean SUVmax in N1-2 patients (n = 82) was 13.6 ± 6.9 (p = 0.02). Uptake in no complete remission (NCR) tended to be higher than in complete remission(CR); The median SUVmax of the NCR (n = 44) was 13.3 ± 6.4 and the median SUVmax of the CR (n = 58) was 8.6 ± 6.0 (p = 0.04). Conclusions: The SUVof the primary tumor was one of the important prognostic factors among the patients treated by radical radiotherapy. Author Disclosure: X. Meng, None; J. Yu, None; S. Liu, None; J. Li, None; Z. Fu, None; X. Sun, None; G. Yang, None; L. Kong, None; A. Han, None.
2432
Relapse Patterns and Related Prognostic Factors in Mobile Tongue Cancer Treated by Postoperative Adjuvant Radiotherapy
S. Kamer1, M. Esassolak2, S. Demirci1, A. Sengul1, A. Yavuzer3 1 Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey, 2Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, Turkey, 3Ege University Faculty of Medicine, Department of Otolarynogology, Izmir, Turkey
Purpose/Objective(s): Squamous cell carcinoma of oral cavity has a worse outcome among head and neck cancers, and the mobile tongue is the most affected site in the oral cavity. The aim of this study is to define relapse patterns and related prognostic factors in mobile tongue cancer treated by postoperative adjuvant radiotherapy. Materials/Methods: Sixty-six consecutive patients with squamous cell carcinoma of mobile tongue who received postoperative radiotherapy between January 1995 and December 2005 were analyzed retrospectively. The extent of surgical resection was determined by the intraoperative findings with the intent being to resect all disease with negative margins if possible. The indication for bilateral neck dissections was palpable adenopathy at presentation. Surgical resection consisted of partial glossectomy alone in 4 patients. Fifty three patients underwent unilateral and 9 patients underwent bilateral neck dissection. Radiotherapy was delivered using with the shrinking field technique and initial portal was designed using standard three-field technique to cover surgical bed and the areas at risk containing nodal disease. Median radiation dose was 6000 cGy (range: 5400–6600 cGy) and first field reduction excluded the spinal cord after 46 Gy. Postoperative radiotherapy was planned to patients with one or more of the following risk factors at final pathology: advanced T stage; margins of resection positive or ‘‘close’’ (defined as tumor within 5 mm from resection edge); invasion of lymphatics and/or blood vessels; perineural invasion; more than one involved lymph node; single node larger than 3 cm; or extracapsular extension on at least one node. Based on postoperative staging; pathologic T stage was as follows: 19% T1, 53% T2, 14% T3, and 14% T4. Results: With a median follow-up for surviving patients of 74 months 5 year disease free, locoregional failure free and cause spesific survival rates were 44%, 46% and 53% respectively. During the analyze locoregional failure was detected in 28 patients. Nineteen of the recurrences were in the primary tumor region, five of them were in the neck, 4 of them were in both. Most of the local failures were experienced in first year (median: 13 months, range: 5–15 months). There were 4 patients that failed distantly; 2 had lung metastasis, 2 had bone metastasis. According to univariate analysis, locoregional control is strongly correlated with surgical margin (p = 0.03), tumor localization (p = 0.00), T stage (p = 0.00), stage (p = 0.00), initial hemoglobine (Hb) level (p = 0.00) and gender (p = 0.04). Total of 36 deaths had occurred: 29 patients had died from progressive disease (range: 7 to 132 months). One patient died from due to second primary tumor (esophageal cancer) and six patients died from the other causes. A significantly higher 5-year overall survival rate was observed among patients with tumors located in lateral side of the tongue compared to those with midline located tumor (72% vs. 25%; p = 0.00), and in those with Hb level .12 g/dl compared to those with a lower Hb level (68% vs. 32%; p = 0.01). Surgical margin status, stage of the disease (p = 0.01) and T stage had also an adverse effect on overall survival (p \ 0.01). Conclusions: Most of the failures were experienced in the primary tumor area. Close follow-up is strongly recommended for these patients especially in two years. Author Disclosure: S. Kamer, None; M. Esassolak, None; S. Demirci, None; A. Sengul, None; A. Yavuzer, None.
2433
The Effect of an Aggressive Enteral Nutritional Program on Daily Setup Variations and Planning Margins of Head and Neck Cancer Patients
A. L. Mercuri1, M. Wada1, A. Rolfo2, D. Lim Joon1, C. A. Mantle1, K. Kaegi1, M. Feigen1, V. Khoo3 1
Austin Health Radiation Oncology Centre, Melbourne VIC, Australia, 2Peter MacCallum Cancer Institute, Melbourne VIC, Australia, 3Royal Marsden Hospital, Department of Radiation Oncology, Sutton Surrey, United Kingdom Purpose/Objective(s): During a course of curative head and neck (H&N) radiotherapy, impacts of response, in terms of tumour regression and possible weight loss, are apparent. Such response plays a factor in altering geometry and possibly radiation dosimetry, leading to potential geometrical target miss and over dosage of organs at risk. At Austin Health, we have a policy of routine pre-treatment nutritional assessment, management and enteral feeding program through the use of the percutaneous endoscopic gastrostomy (PEG) tube for selected cases.
S443