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Safety and Efficacy of Lessening the Dose-Volume Limits of Brainstem to Improve Local Control in Local Advanced Nasopharyngeal Carcinoma
E338
International Journal of Radiation Oncology Biology Physics
Conclusion: In OPSCC patients, we found both nodal and primary CR at the w3 mos PET/CT predicts for improved survival outcomes. Patients who have a PR at postPET1 have high CR rates at PETpost2 and overall low subsequent failure rates. In select patients, it is reasonable to obtain a follow up PET/CT at w6 mos to ensure resolution of PET activity. Author Disclosure: N. Nolan: None. C.L. Wright: Research Grant; American Cancer Society, RSNA. V.M. Diavolitsis: None. D. Blakaj: None. J.P. McElroy: None. J.C. Grecula: None. A.D. Bhatt: None.
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2839 The Importance of Self-Care Rehabilitation in Irradiated Head and Neck Cancer Patients M. Caloglu, V. Yurut Caloglu, F. Ozdemir, and S. Yavuz; Trakya University, Edirne, Turkey Purpose/Objective(s): Restricted mouth opening (trismus) is a very common late effect following head and neck cancer treatments. Rehabilitation exercises are believed to be mostly influential, yet there have been limited studies covering this particular subject. This study aims to reveal whether rehabilitation therapy utilized after radiation therapy (RT) has effective therapeutic impact on mouth opening in head and neck cancer patients (pts). Materials/Methods: Fifty-four consecutive pts with squamous cell carcinoma of the head and neck treated with RT chemotherapy (ChT) were included in the study. Conventional 2- or 3-dimensional conformal RT techniques were used to treat the pts with a dose of 60 to 70 Gy based on the T stage. Three cycles of concurrent cisplatin (CDDP), either every 3 weeks at 100 mg/m2 or at weekly intervals at 40 mg/m2, was delivered. The mouth opening distance is less than 35 mm accepted as trismus. The first measurement was made at least 3 months after RT. The following exercises were performed by the pts: i) to open the mouth to the full extent ii) to move the lower jaw to the right, iii) left and iv) forward. Each exercise lasted for 3 seconds and repeated 5 times in a set, 3 times a day. The chi-square two-tailed test and the Fisher exact test were used for statistical analysis. A 2-sided 5% significance level was used for the comparison of the groups. Results: The median age was 59 years (range: 31-84). Eighty percent of the pts were male. The most common primary tumor site was the larynx (60.4%). Twenty-six pts (48%) had advanced T3-4 disease. Twentyeight pts (52.8%) underwent adjuvant RT. Thirty-four pts (63%) were treated with concomitant ChT and RT and 20 pts (37%) were treated with RT alone. The mean RT dose was 63.1 Gy (range: 30-74 Gy). The mean mouth opening measurements were 37.1 mm (range: 8-62 mm) and 38.5 mm (range: 10-62 mm) before and after physiotherapy, respectively (P<.0001). There was a statistically significant negative correlation between the mouth opening distance and the time past after RT (PZ.046). However, this correlation lost its significance by physiotherapy (P>.05). The mouth opening less than 35 mm was measured in 23 pts (42.6%) pre-physiotherapy whereas in 16 pts (29.6%) postphysiotherapy. The mean mouth opening distance was significantly lower for the pts who received concurrent ChT (PZ.032) and with advanced T stage (PZ.004). Moreover, whether they received concurrent ChT (P<.0001) or not (P<.0001), the pts were positively affected by physiotherapy. The mean value of mouth opening increased significantly in pts with T1 (PZ.006), T2 (PZ.002), and T4 (PZ.001) stage postphysiotherapy. Conclusion: The self-rehabilitation method used in this study was found effective for the treatment of trismus in head and neck cancer patients particularly with higher T stages and received concurrent ChT and RT. This promising result warrants phase 3 testing of such self-rehabilitation method to such patients. Author Disclosure: M. Caloglu: None. V. Yurut Caloglu: None. F. Ozdemir: None. S. Yavuz: None.
Safety and Efficacy of Lessening the Dose-Volume Limits of Brainstem to Improve Local Control in Local Advanced Nasopharyngeal Carcinoma B. Chen, L. Gao, J.W. Luo, J. Yi, J.P. Xiao, X.D. Huang, Y. Qu, G.Z. Xu, S.P. Zhang, K. Wang, and Z. Yin; Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Purpose/Objective(s): Nasopharyngeal carcinoma patients with T3 and T4 stage have the base-of-skull and intracranial invasion, which limited tumor dose coverage of intensity modified radiation therapy (IMRT) because of the strict dose constraint of brainstem. This study aims to evaluate the safety of lessening the dose-volume limits of brainstem for achieving better dose coverage to primary tumor, and to investigate the efficacy to improve local control in local advanced nasopharyngeal carcinoma. Materials/Methods: One hundred thirty-eight patients with local advanced nasopharyngeal carcinoma (71 T3 and 67 T4) were enrolled this study between January 2012 and December 2012. Planning target volume of primary gross tumor (PGTVnx) was delivered 2.24w2.40 Gy per fraction, once fraction per day, Monday to Friday for 33 fractions for a total dose of 70w80 Gy by using IMRT. The margins of planning organs at risk volume were 3mm for brainstem (PRV-brainstem). PRV-brainstem of 69 patients (50%) were received 60Gy of more than 1 mL，15 patients (11%) of more than 5 mL. In addition, PRV-brainstem of 40 patients (29%) was received 65Gy of more than 1 mL，8 patients (6%) of more than 3 mL. One hundred twelve patients (81%) were treated with concomitant chemotherapy consisting of cisplatin alone, 12 patients were received 2 cycles induction chemotherapy. Results: With a median follow-up of 28 months, no brainstem injury was observed. The 2-year local control rate was 94%, and overall survival (OS) was 92%. Distant metastasis was the primary failure pattern, and the 2year distant metastasis free survival (DMFS) was 81%. For T4 patients, the 2-year local control rate, OS and DMFS were 90%, 86% and 77%, respectively. Most patients tolerated treatment relatively well, 76% (85/ 112) patients completed concomitant chemotherapy with more than 300mg cisplatin. Conclusion: Patients with local advanced nasopharyngeal carcinoma achieved excellent local control and improved survival by lessening the dose-volume limits of brainstem to improve the dose coverage of primary tumor. It was safe that brainstem were received 60 Gy of less than 5 mL and 65 Gy of less than 3 mL within 2 years follow-up. Even this limitation should be considered to exceed when the primary tumor violated brainstem. However, long-term follow-up of patients in this study should be carried out to observe possible late injury of brainstem. Author Disclosure: B. Chen: None. L. Gao: None. J. Luo: None. J. Yi: None. J. Xiao: None. X. Huang: None. Y. Qu: None. G. Xu: None. S. Zhang: None. K. Wang: None. Z. Yin: None.
2841 Oncological Outcome and Toxicity With Upfront Neck Dissection Prior Chemoradiation Therapy for Clinically Node Positive Head and Neck Squamous Cell Carcinoma O. Elicin,1 T. Albrecht,1 A.G. Haynes,2 B. Bojaxhiu,1 L. Nisa,1,2 M. Caversaccio,1 A. Dal Pra,1 M. Schmuecking,1 D.M. Aebersold,1 and R. Giger1; 1Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 2University of Bern, Bern, Switzerland Purpose/Objective(s): There is a lack of evidence about up-front neck dissection (UFND) performed before radiation therapy with or without concomitant chemotherapy ([C]RT) for head and neck squamous cell carcinoma (HNSCC). Our aim was to compare the outcome and toxicity with and without UFND in organ-preserving (C)RT strategy.
International Journal of Radiation Oncology Biology Physics
Conclusion: In OPSCC patients, we found both nodal and primary CR at the w3 mos PET/CT predicts for improved survival outcomes. Patients who have a PR at postPET1 have high CR rates at PETpost2 and overall low subsequent failure rates. In select patients, it is reasonable to obtain a follow up PET/CT at w6 mos to ensure resolution of PET activity. Author Disclosure: N. Nolan: None. C.L. Wright: Research Grant; American Cancer Society, RSNA. V.M. Diavolitsis: None. D. Blakaj: None. J.P. McElroy: None. J.C. Grecula: None. A.D. Bhatt: None.
2840
2839 The Importance of Self-Care Rehabilitation in Irradiated Head and Neck Cancer Patients M. Caloglu, V. Yurut Caloglu, F. Ozdemir, and S. Yavuz; Trakya University, Edirne, Turkey Purpose/Objective(s): Restricted mouth opening (trismus) is a very common late effect following head and neck cancer treatments. Rehabilitation exercises are believed to be mostly influential, yet there have been limited studies covering this particular subject. This study aims to reveal whether rehabilitation therapy utilized after radiation therapy (RT) has effective therapeutic impact on mouth opening in head and neck cancer patients (pts). Materials/Methods: Fifty-four consecutive pts with squamous cell carcinoma of the head and neck treated with RT chemotherapy (ChT) were included in the study. Conventional 2- or 3-dimensional conformal RT techniques were used to treat the pts with a dose of 60 to 70 Gy based on the T stage. Three cycles of concurrent cisplatin (CDDP), either every 3 weeks at 100 mg/m2 or at weekly intervals at 40 mg/m2, was delivered. The mouth opening distance is less than 35 mm accepted as trismus. The first measurement was made at least 3 months after RT. The following exercises were performed by the pts: i) to open the mouth to the full extent ii) to move the lower jaw to the right, iii) left and iv) forward. Each exercise lasted for 3 seconds and repeated 5 times in a set, 3 times a day. The chi-square two-tailed test and the Fisher exact test were used for statistical analysis. A 2-sided 5% significance level was used for the comparison of the groups. Results: The median age was 59 years (range: 31-84). Eighty percent of the pts were male. The most common primary tumor site was the larynx (60.4%). Twenty-six pts (48%) had advanced T3-4 disease. Twentyeight pts (52.8%) underwent adjuvant RT. Thirty-four pts (63%) were treated with concomitant ChT and RT and 20 pts (37%) were treated with RT alone. The mean RT dose was 63.1 Gy (range: 30-74 Gy). The mean mouth opening measurements were 37.1 mm (range: 8-62 mm) and 38.5 mm (range: 10-62 mm) before and after physiotherapy, respectively (P<.0001). There was a statistically significant negative correlation between the mouth opening distance and the time past after RT (PZ.046). However, this correlation lost its significance by physiotherapy (P>.05). The mouth opening less than 35 mm was measured in 23 pts (42.6%) pre-physiotherapy whereas in 16 pts (29.6%) postphysiotherapy. The mean mouth opening distance was significantly lower for the pts who received concurrent ChT (PZ.032) and with advanced T stage (PZ.004). Moreover, whether they received concurrent ChT (P<.0001) or not (P<.0001), the pts were positively affected by physiotherapy. The mean value of mouth opening increased significantly in pts with T1 (PZ.006), T2 (PZ.002), and T4 (PZ.001) stage postphysiotherapy. Conclusion: The self-rehabilitation method used in this study was found effective for the treatment of trismus in head and neck cancer patients particularly with higher T stages and received concurrent ChT and RT. This promising result warrants phase 3 testing of such self-rehabilitation method to such patients. Author Disclosure: M. Caloglu: None. V. Yurut Caloglu: None. F. Ozdemir: None. S. Yavuz: None.
Safety and Efficacy of Lessening the Dose-Volume Limits of Brainstem to Improve Local Control in Local Advanced Nasopharyngeal Carcinoma B. Chen, L. Gao, J.W. Luo, J. Yi, J.P. Xiao, X.D. Huang, Y. Qu, G.Z. Xu, S.P. Zhang, K. Wang, and Z. Yin; Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China Purpose/Objective(s): Nasopharyngeal carcinoma patients with T3 and T4 stage have the base-of-skull and intracranial invasion, which limited tumor dose coverage of intensity modified radiation therapy (IMRT) because of the strict dose constraint of brainstem. This study aims to evaluate the safety of lessening the dose-volume limits of brainstem for achieving better dose coverage to primary tumor, and to investigate the efficacy to improve local control in local advanced nasopharyngeal carcinoma. Materials/Methods: One hundred thirty-eight patients with local advanced nasopharyngeal carcinoma (71 T3 and 67 T4) were enrolled this study between January 2012 and December 2012. Planning target volume of primary gross tumor (PGTVnx) was delivered 2.24w2.40 Gy per fraction, once fraction per day, Monday to Friday for 33 fractions for a total dose of 70w80 Gy by using IMRT. The margins of planning organs at risk volume were 3mm for brainstem (PRV-brainstem). PRV-brainstem of 69 patients (50%) were received 60Gy of more than 1 mL，15 patients (11%) of more than 5 mL. In addition, PRV-brainstem of 40 patients (29%) was received 65Gy of more than 1 mL，8 patients (6%) of more than 3 mL. One hundred twelve patients (81%) were treated with concomitant chemotherapy consisting of cisplatin alone, 12 patients were received 2 cycles induction chemotherapy. Results: With a median follow-up of 28 months, no brainstem injury was observed. The 2-year local control rate was 94%, and overall survival (OS) was 92%. Distant metastasis was the primary failure pattern, and the 2year distant metastasis free survival (DMFS) was 81%. For T4 patients, the 2-year local control rate, OS and DMFS were 90%, 86% and 77%, respectively. Most patients tolerated treatment relatively well, 76% (85/ 112) patients completed concomitant chemotherapy with more than 300mg cisplatin. Conclusion: Patients with local advanced nasopharyngeal carcinoma achieved excellent local control and improved survival by lessening the dose-volume limits of brainstem to improve the dose coverage of primary tumor. It was safe that brainstem were received 60 Gy of less than 5 mL and 65 Gy of less than 3 mL within 2 years follow-up. Even this limitation should be considered to exceed when the primary tumor violated brainstem. However, long-term follow-up of patients in this study should be carried out to observe possible late injury of brainstem. Author Disclosure: B. Chen: None. L. Gao: None. J. Luo: None. J. Yi: None. J. Xiao: None. X. Huang: None. Y. Qu: None. G. Xu: None. S. Zhang: None. K. Wang: None. Z. Yin: None.
2841 Oncological Outcome and Toxicity With Upfront Neck Dissection Prior Chemoradiation Therapy for Clinically Node Positive Head and Neck Squamous Cell Carcinoma O. Elicin,1 T. Albrecht,1 A.G. Haynes,2 B. Bojaxhiu,1 L. Nisa,1,2 M. Caversaccio,1 A. Dal Pra,1 M. Schmuecking,1 D.M. Aebersold,1 and R. Giger1; 1Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland, 2University of Bern, Bern, Switzerland Purpose/Objective(s): There is a lack of evidence about up-front neck dissection (UFND) performed before radiation therapy with or without concomitant chemotherapy ([C]RT) for head and neck squamous cell carcinoma (HNSCC). Our aim was to compare the outcome and toxicity with and without UFND in organ-preserving (C)RT strategy.