- Email: [email protected]
CT in Predicting Survival in Oropharyngeal Squamous Cell Carcinoma
Volume 93 Number 3S Supplement 2015 radiation therapy planning system (CMS). The patients received repeated thyrotropin (TSH) assessments. Hypothyroidism was defined as serum TSH > 4.0 mU/L. The Kaplan-Meier method was used to estimate incident rate of radiation induced HT. Results: The median follow-up was 49 months (range, 6-71 months). Radiation-induced HT occurred in 42 patients (51.8%). Of these 42 patients, 23 patients (54.8%) were considered to have clinical HT and were treated with levothyroxine. HT developed after a median interval of 13 months (range 2e55 months). The cumulative risk of HT in all patients after 1, 2, 3 and 4 years of irradiation was 9.9%, 25.3%, 31.8% and 43.1%, respectively. In the DVH analysis, VS10, VS20, VS30, and VS40 were significantly associated with radiation induced HT. Conclusion: Radiation-induced HT was frequently observed as late radiation toxicity and thyroid function should be monitored routinely after RT. In this study, the volume of thyroid gland spared from doses 10, 20, 30, and 40Gy might be factors that increased the risk of radiation induced HT. Further accumulation of patients and prospective study would be warranted. Author Disclosure: D. Miyawaki: None. N. Mukumoto: None. Y. Ejima: None. K. Yoshida: None. T. Ishihara: None. N. Kiyota: None. M. Saito: None. N. Otsuki: None. K. Nibu: None. R. Sasaki: None.
2837 The Voxel-based Analysis of FMISO-PET Image in Patients With Local Recurrence of Nasopharyngeal Carcinoma Y. Nishikawa,1 K. Yasuda,2 S. Okamoto,2 Y.M. Ito,3 T. Mori,1 R. Onimaru,2 T. Shiga,2 K. Tsuchiya,1 S. Watanabe,2 W. Takeuchi,4 N. Katoh,1,5 Y. Kuge,6 N. Tamaki,2 and H. Shirato2,5; 1Hokkaido University Hospital, Sapporo, Japan, 2Hokkaido University Graduate School of Medicine, Sapporo, Japan, 3Hokkaido University Graduate School of Medicine, Hokkaido, Japan, 4Hitachi Ltd., Hitachi, Japan, 5 Hokkaido University, Sapporo, Japan, 6Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan Purpose/Objective(s): Hypoxia in tumor is thought to be radioresistant and have some impact on local recurrence after radiation therapy (RT). One of the major hypoxic images is [18F] FMISO-PET. The object of this study was to evaluate the impact of FMISO-PET performed before radiation therapy (pre-RT) for predicting the site of recurrence using voxelbased analysis. Materials/Methods: Forty patients with nasopharyngeal carcinoma (NPC) received RT at our institution from April 2008 to December 2014. Twenty-nine of them were conducted [18F] FMISO-PET before RT using a high-resolution PET which has semiconductor detector (semiconductor PET). The performance of the PET was previously reported and the spatial resolution is very high (2.3 mm FWHM). In this preliminary study, 8 patients who received radical RT and had local recurrence were analyzed. The image data of pre-RT FMISO-PET, the pre-RT CT image, and the CT at the local relapse were imported to the in-house software. These images were fused, and the ROI of primary and recurrence tumor were contoured. The MRI and FDG-PET image were also fused in order to assist contouring. The voxel data of FMISO-PET located inside the primary tumor were exported with the information whether the voxel overlapped with the site of recurrence or not. The voxel data of FMISOPET were divided into two groups; overlapped with the site of recurrence (group A) and did not (group B). The each voxel date had information about a degree of accumulation of FMISO expressed in tumor-muscle ratio (TMR). Logistic regression analysis was used to examine the association between TMR of FMISO and the probability of overlapping with recurrence in each voxel. Receiver operating characteristics (ROC) curve analysis was performed. Results: Among 81,210 voxels, the number of group A was 14,426 and group B was 66,784. The TMR (mean SD) were significantly higher in group A (1.00 0.29) than group B (0.86 0.17) (P<.0001). On logistic regression analysis, the odds ratio was calculated as 18.3 (95%
Poster Viewing Session E337 CI Z 16.8-19.9). The area under the curve (AUC) of the ROC curve was 0.636. Conclusion: The recurrence in the primary region of NPC was more frequent in the high accumulation area of FMISO before radiation therapy in relapsed patients. Predictive value of FMISO-PET before radiation therapy should be investigated further. Semiconductor PET was suggested to be clinically useful for quantitative analysis about intra-tumoral heterogeneity of radiation sensitivity. Author Disclosure: Y. Nishikawa: None. K. Yasuda: None. S. Okamoto: None. Y.M. Ito: None. T. Mori: None. R. Onimaru: None. T. Shiga: None. K. Tsuchiya: None. S. Watanabe: None. W. Takeuchi: None. N. Katoh: None. Y. Kuge: None. N. Tamaki: None. H. Shirato: Research Grant; Hitachi Ltd, Mitsubishi Heavy Industries Ltd, Shimadzu Corporation.
2838 Significance of Posttreatment 18F-FDG PET/CT in Predicting Survival in Oropharyngeal Squamous Cell Carcinoma N. Nolan,1 C.L. Wright,1 V.M. Diavolitsis,1 D. Blakaj,1 J.P. McElroy,1 J.C. Grecula,2 and A.D. Bhatt1; 1Ohio State University Wexner Medical Center, Columbus, OH, 2The Ohio State University Wexner Medical Center, Columbus, OH Purpose/Objective(s): Use of pretreatment 18Flourine-fluorodeoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET/CT) in staging locally advanced oropharyngeal squamous cell carcinoma (OPSCC) is common practice. Current NCCN guidelines suggest imaging within 6 months of the completion of therapy, which is typically PET/CT. Studies have shown response assessment is predictive of locoregional failure (LRF). The ideal timing of PET/CT is not established, but is typically at 3 months (mos) to decrease false positive readings from post-treatment inflammatory changes. Management of patients with positive findings at 3 mos varies between physicians. Additional PET/CT at w6 mos is obtained by some if the 3 mos PET/CT continued to be abnormal. We analyzed both w3 mos (PETpost1) and w6 mos (PETpost2) to correlate response to survival outcomes. Materials/Methods: We retrospectively reviewed 230 OPSCC patients treated with radiation therapy from 2010 to 2013. Of these, 169 were eligible having both pre and PETpost1, and 38/169 had a PETpost2. Both postoperative patients with any persistent gross disease, primary or nodal (nZ26), and definitively (nZ143) treated patients were included. One hundred fifty-nine received systemic therapy, cetuximab (nZ46), or platinum-based (nZ113) and 10 did not. PET/CT response was classified at both the primary and nodal sites as complete response (CR-no residual uptake or uptake less than blood pool), partial response (PR-decrease in SUV max but not a CR) or increased SUV max (ISM). Statistics utilizing Kaplan-Meier and Cox Regression models were conducted for univariate and multivariate analyses (MVA). Results: Median age was 58 and 81.6% were male. P16 was positive in 83%. At median follow up of 24.3 mos (3.3-56.1), there were 27 pathologically proven LRF (13 neck, 14 primary) and 24 people had died. At PETpost1 there were 4/97 CR and 9/71 PR nodal, and 2/94 CR and 12/73 PR primary site patients who failed. Of the 72 nodal and 75 primary PR/ ISM, 38 underwent PETpost2. Of these 38 there were 5 patients who failed, 1/25 CR and 1/3 ISM nodal, and 2/27 CR and 1/6 PR primary failures. On MVA, nodal CR at PETpost1 predicted for improved 2 yr disease free survival (DFS-80% vs 61.3%, PZ.021), 2-year local relapsefree survival (LRFS-93% vs 72%, PZ.004) and 2-year overall survival (OS-89% vs 83%, PZ<.001), while primary CR predicted for improved 2-year LRFS (91% vs 76% PZ.035). Use of platinum based chemotherapy (vs. cetuximab) predicted for improved OS (PZ.002) and DFS (PZ.011), and p16 positivity predicted for improved DFS (PZ.021), and OS (PZ<.001).
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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.
2837 The Voxel-based Analysis of FMISO-PET Image in Patients With Local Recurrence of Nasopharyngeal Carcinoma Y. Nishikawa,1 K. Yasuda,2 S. Okamoto,2 Y.M. Ito,3 T. Mori,1 R. Onimaru,2 T. Shiga,2 K. Tsuchiya,1 S. Watanabe,2 W. Takeuchi,4 N. Katoh,1,5 Y. Kuge,6 N. Tamaki,2 and H. Shirato2,5; 1Hokkaido University Hospital, Sapporo, Japan, 2Hokkaido University Graduate School of Medicine, Sapporo, Japan, 3Hokkaido University Graduate School of Medicine, Hokkaido, Japan, 4Hitachi Ltd., Hitachi, Japan, 5 Hokkaido University, Sapporo, Japan, 6Central Institute of Isotope Science, Hokkaido University, Sapporo, Japan Purpose/Objective(s): Hypoxia in tumor is thought to be radioresistant and have some impact on local recurrence after radiation therapy (RT). One of the major hypoxic images is [18F] FMISO-PET. The object of this study was to evaluate the impact of FMISO-PET performed before radiation therapy (pre-RT) for predicting the site of recurrence using voxelbased analysis. Materials/Methods: Forty patients with nasopharyngeal carcinoma (NPC) received RT at our institution from April 2008 to December 2014. Twenty-nine of them were conducted [18F] FMISO-PET before RT using a high-resolution PET which has semiconductor detector (semiconductor PET). The performance of the PET was previously reported and the spatial resolution is very high (2.3 mm FWHM). In this preliminary study, 8 patients who received radical RT and had local recurrence were analyzed. The image data of pre-RT FMISO-PET, the pre-RT CT image, and the CT at the local relapse were imported to the in-house software. These images were fused, and the ROI of primary and recurrence tumor were contoured. The MRI and FDG-PET image were also fused in order to assist contouring. The voxel data of FMISO-PET located inside the primary tumor were exported with the information whether the voxel overlapped with the site of recurrence or not. The voxel data of FMISOPET were divided into two groups; overlapped with the site of recurrence (group A) and did not (group B). The each voxel date had information about a degree of accumulation of FMISO expressed in tumor-muscle ratio (TMR). Logistic regression analysis was used to examine the association between TMR of FMISO and the probability of overlapping with recurrence in each voxel. Receiver operating characteristics (ROC) curve analysis was performed. Results: Among 81,210 voxels, the number of group A was 14,426 and group B was 66,784. The TMR (mean SD) were significantly higher in group A (1.00 0.29) than group B (0.86 0.17) (P<.0001). On logistic regression analysis, the odds ratio was calculated as 18.3 (95%
Poster Viewing Session E337 CI Z 16.8-19.9). The area under the curve (AUC) of the ROC curve was 0.636. Conclusion: The recurrence in the primary region of NPC was more frequent in the high accumulation area of FMISO before radiation therapy in relapsed patients. Predictive value of FMISO-PET before radiation therapy should be investigated further. Semiconductor PET was suggested to be clinically useful for quantitative analysis about intra-tumoral heterogeneity of radiation sensitivity. Author Disclosure: Y. Nishikawa: None. K. Yasuda: None. S. Okamoto: None. Y.M. Ito: None. T. Mori: None. R. Onimaru: None. T. Shiga: None. K. Tsuchiya: None. S. Watanabe: None. W. Takeuchi: None. N. Katoh: None. Y. Kuge: None. N. Tamaki: None. H. Shirato: Research Grant; Hitachi Ltd, Mitsubishi Heavy Industries Ltd, Shimadzu Corporation.
2838 Significance of Posttreatment 18F-FDG PET/CT in Predicting Survival in Oropharyngeal Squamous Cell Carcinoma N. Nolan,1 C.L. Wright,1 V.M. Diavolitsis,1 D. Blakaj,1 J.P. McElroy,1 J.C. Grecula,2 and A.D. Bhatt1; 1Ohio State University Wexner Medical Center, Columbus, OH, 2The Ohio State University Wexner Medical Center, Columbus, OH Purpose/Objective(s): Use of pretreatment 18Flourine-fluorodeoxyglucose (18F-FDG) positron emission tomography and computed tomography (PET/CT) in staging locally advanced oropharyngeal squamous cell carcinoma (OPSCC) is common practice. Current NCCN guidelines suggest imaging within 6 months of the completion of therapy, which is typically PET/CT. Studies have shown response assessment is predictive of locoregional failure (LRF). The ideal timing of PET/CT is not established, but is typically at 3 months (mos) to decrease false positive readings from post-treatment inflammatory changes. Management of patients with positive findings at 3 mos varies between physicians. Additional PET/CT at w6 mos is obtained by some if the 3 mos PET/CT continued to be abnormal. We analyzed both w3 mos (PETpost1) and w6 mos (PETpost2) to correlate response to survival outcomes. Materials/Methods: We retrospectively reviewed 230 OPSCC patients treated with radiation therapy from 2010 to 2013. Of these, 169 were eligible having both pre and PETpost1, and 38/169 had a PETpost2. Both postoperative patients with any persistent gross disease, primary or nodal (nZ26), and definitively (nZ143) treated patients were included. One hundred fifty-nine received systemic therapy, cetuximab (nZ46), or platinum-based (nZ113) and 10 did not. PET/CT response was classified at both the primary and nodal sites as complete response (CR-no residual uptake or uptake less than blood pool), partial response (PR-decrease in SUV max but not a CR) or increased SUV max (ISM). Statistics utilizing Kaplan-Meier and Cox Regression models were conducted for univariate and multivariate analyses (MVA). Results: Median age was 58 and 81.6% were male. P16 was positive in 83%. At median follow up of 24.3 mos (3.3-56.1), there were 27 pathologically proven LRF (13 neck, 14 primary) and 24 people had died. At PETpost1 there were 4/97 CR and 9/71 PR nodal, and 2/94 CR and 12/73 PR primary site patients who failed. Of the 72 nodal and 75 primary PR/ ISM, 38 underwent PETpost2. Of these 38 there were 5 patients who failed, 1/25 CR and 1/3 ISM nodal, and 2/27 CR and 1/6 PR primary failures. On MVA, nodal CR at PETpost1 predicted for improved 2 yr disease free survival (DFS-80% vs 61.3%, PZ.021), 2-year local relapsefree survival (LRFS-93% vs 72%, PZ.004) and 2-year overall survival (OS-89% vs 83%, PZ<.001), while primary CR predicted for improved 2-year LRFS (91% vs 76% PZ.035). Use of platinum based chemotherapy (vs. cetuximab) predicted for improved OS (PZ.002) and DFS (PZ.011), and p16 positivity predicted for improved DFS (PZ.021), and OS (PZ<.001).
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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.