- Email: [email protected]
Subjective and objective evaluation of xerostomia after intensity modulated radiation therapy (IMRT) of nasopharyngeal cancer: Preliminary results
-$77
Posters improve storage and interchanging patient information as well as to simplify the access to these data for research purpose. Materials/Methods: SPIDER-H&N (System for Patient Individual Data Entry and Recording in Otolaryngology) is a system based on integrated palm technology, through Intra-lnternet connection, used in our Center to facilitate data recording, archiving, managing and sharing of patients with H&N cancer. This software is able to store all data of those patients who are candidated to any multi-modality treatment. Results: From February 2006, more than 200 patients affected by H&N cancer and treated in our Institution were recorded until now. The system can monitor and trace the various aspects of the clinical management: dates and settings of predicted medical examinations, concomitant or sequential chemotherapy, according to a schedule of treatment chosen by the multidisciplinary team for each patient, response evaluation, timing of surgery and follow-up appointments. Spider-ORL is also able to interact with the hospital system of patient database to capture any information relative to the patient hospitalization and accessible via intranet (identifying, laboratory data, radiological imaging, surgery description, pathology results). All these data are transferred into an electronic archive which can be shared and updated online by all the specialists, even through palm-PC and wireless technology. These data are so available in real time to the single specialist and readable through statistical analysis packages for research purpose. Conclusions: Easing the communication and exchange of clinical informations and data among the specialties involved in patient treatment is nowadays mandatory to optimize data collection, ameliorate the treatment, and therefore improve the outcome of patients. Spider-ORL proved to be a very useful tool in capturing information where it is generated, allowing to overcome the presence of multiple places, times and archiving data modalities, characteristic of any multidisciplinary treatment. 210 poster STAGED NECK DISSECTION (ND) PRE- OR POST-CHEMORADIOTHERAPY (CRT) IS ASSOCIATED WITH IMPROVED DISEASE-FREE SURVIVAL (DFS) BUT NOT OVERALL SURVIVAL (OS) IN LOCALLY ADVANCED OROPHARYNGEAL SQUAMOUS CELL CARCINOMA (OPHSCC)- 20-YEAR EXPERIENCE FROM A SINGLE CENT A, Kirby, M. O'Connell GUY'SANDST. THOMAS'NHS FOUNDATIONTRUST,Clinical Oncology, London,
UK Purpose/Objective: The role and timing of ND in the management of locally advanced OPhSCC remains controversial. There are no prospective randomised controlled trials. We present 20-year results defining the effect of ND upon DFS, OS and complications. Materials/Methods: 312 patients with OPhSCC treated with CRT between 1985 and 2006 were reviewed. There were 240 males and 69 females of mean age 59 years (range 38-90). Tumour sites included tonsil 174; tongue base 87; soft palate 28; posterior pharyngeal wall 12; unspecified 11. 268 had advanced disease (stage III 31, stage IV 237). 231 were treated with radical intent. ND was performed in 88 patients pre-CRT and in 18 patients post-CRT. 125 patients were treated with CRT alone. Median follow-up was 21 months (range 1-207). Results: CRT alone S-year DFS and OS were 50% and 53% respectively. 34/125 (27%) recurred locally: 8 were salvaged, 6 with surgery, and 2 with surgery & brachytherapy. 26 died with local recurrence. 6/125 (5%) died of distant metastatic disease. 3 died of other causes. Complications included fatal neutropenic sepsis (1), radiation myelitis (1), tracheocutaneous fistula (1). 6 patients were PEG-dependent for ~12 months, 4 for ~24 months. ND
5-year DFS and OS were 61% and 55% respectively. Of 41 patients treated with pre-CRT ND, 15% recurred locally and had positive margins + extra-capsular spread. 4 died and 2 were surgically salvaged. 5% died of distant metastases. 1 patient died immediately post-operatively of a CVA. 1 refused CRT and died of local progression. 5/41 (12%) patients were PEG-dependent 712 months, 3 for ~24 months. 2 patients had delayed wound healing and one persistent severe shoulder pain. Of the 18 patients treated with post-CRT ND, 2 (11%) recurred locally and died, one having positive ND margins. 1 patient died of distant metastases. 1 patient died of NSCLC and 1 of unknown cause. 1 patient suffered a prolonged wound infection. 6% were PEG-dependent 712 months. Comparison between the CRT-alone and ND groups using the logrank test shows significantly improved DFS (p=0.04) for staged ND but not OS (p=0.189). Clinical/radiological findings post-CRT ND 15/18 had residual palpable LNs at completion of CRT: residual disease was confirmed on cytology in 2; 1 had false-positive PET scan at 3 months but negative pathology subsequently. Conclusions: Staged ND has significantly increased 5-year DFS (61% vs 50%, p=0.04) but not OS (55% vs 53%, p=0.189). Staged ND prior to CRT is associated with prolonged dysphagia & delayed wound healing. Clincal trials are underway to assess whether FDG-PET postCRT is a better predictor of who needs ND than clinical/CT findings. 211 poster SUBJECTIVE AND OBJECTIVE EVALUATION OF XEROSTOMIA AFTER INTENSITY MODULATED RADIATION THERAPY (IMRT) OF NASOPHARYNGEAL CANCER: PRELIMINARY RESULTS. L. MaruccF, S. MarzP, G. Giovinazzo~,M. Benassi ~,M. 8enassi2,G. Arcangeli ~ 1REGINAELENA~Radiation Oncology, Rome, Italy, 2REGINAELENA,Medical Physics, Rome, Italy
Purpose/Objective: Xerostomia is a common side effect that impairs the quality of life of patients treated with radiotherapy for nasopharyngeal cancer. IMRT, with high dose gradients, offers the opportunity for delivering high doses with optimal target coverage and concurrent sparing of organs at risk such as the parotids. The purpose of this study is to prospectively evaluate subjectively, using a questionnaire, and objectively, measuring the un-stimulated and stimulated salivary flux, xerostomia in patients treated with IMRT for nasopharyngeal cancer. Materials/Methods: In our Department, IMRT has been used to treat NPC since March 2003. A total of 3S patients have been treated until April 2006:14 patients with stage I-II, and 21 with stage Ill-IV disease. Chemotherapy with Cisplatinum was used in all but 4 patients. The median total planned dose was 70 Gy (range 70-74 Gy) in 33-35 fractions for the macroscopic disease (primary and lymph nodes), 60 Gy in 33 fractions for node echelons at high risk of microscopic spread and 54 Gy in 33 fractions for those at intermediate risk. All the patients answered a questionnaire evaluating the functions that are impaired by the lack of saliva. In particular, the general comfort of the oral cavity, chewing, swallowing, tasting, speaking, sleeping and the need to continuously sip water were evaluated. At the same time the flux of saliva at rest and stimulated by chewing was measured. The xerostomia evaluation was done prior to therapy and repeated after 3, 6, 12, 18, 24 months. Results: 30 patients with a median follow up of 20 months (range 6-35) were included in this preliminary analysis. The mean parotid glands dose was 34,3 Gy. None of the patients experienced recurrence at the primary or neck side. At three months after the completion of radiotherapy the majority of patients experienced severe xerostomia and consequently a very impaired quality of life. A significant improvement occurred in the following evaluations in all the parameters considered. The greatest recovery occurred between
$78 -
Posters 6 and 18 months. At 18 months the mean value of un-stimulated and stimulated saliva flux returned to 28% and 55% of baseline, respectively. The improvement in xerostomia was also reflected in a significant improvement in the questionnaire score. The recovery in sleeping and tasting were the most pronounced. Upon multivariate analysis, the question evaluating the general comfort of the mouth was the one with the strongest correlation with the salivary flux. Conclusions: IMRT in early and locally advanced nasopharyngeal cancer permits a decrease in dose to the parotid glands without compromising local control. Such dose reduction is important because it allows the parotid glands to significantly recover their function in time, mainly between 6 and 18 months after the completion of therapy, with a consequent significant improvement of all the function impaired by xerostomia and consequently in the patients quality of life. 212 poster SURGERYAND RADIOTHERAPYINTHETREATMENTOF MALIGNANT PAROTIDTUMORS: A RETROSPECTIVEMULTICENTERSTUDY M. Amichetti~,M. NagliatF, A. Bolner2,V.Vanoni 2,L.Tomio2,GC. Lay3,R. Murtas 3,MA. Deidda3, A. Madeddu4,E. Delmastro4, R.Verna4,P. Gabriele4 1PROTONTHERAPYPROVINCIALAGENCY,dept, Trento, Italy, 20SPEDALESANTACHIARA~Department of Radiation Oncology, Trento,
Italy, 30SPEDALEONCOLOGIco-A.BUSlNCO,Department of Radiation Oncology,
Cagfiari, Italy, 4INSTITUTEOF CANCERRESEARCH,Department of Radiation Oncology, Can-
diolo-Torino, Italy Purpose/Objective: Salivary gland carcinomas are a rare and clinically diverse group of neoplasms. The optimal management of malignant parotid gland tumours remains to be defined precisely. Usually, the combination of surgery (parotidectomy) and radiation therap (RT) is considered the treatment of choice, being radiation therapy alone reserved for palliation or definitive treatment of inoperable lesions. A retrospective, multicenter study was conducted to review the results of the treatment of malignant parotid tumors analyzing patterns of treatment failure and clinical outcomes. Materials/Methods: A retrospective chart review of clinical and pathologic data of the patients treated for malignant parotid tumors at three institutions (Trento, Cagliari, and Candiolo-Torino) from 1993 to 2004 was made.There were 111 patients aged between 22 and 95 years (median age: 66 years); 61 cases were males and 44. females. Six patients with non-Hodgkin's lymphoma were excluded from the analysis. Pathology files of the remaining 105 evaluable cases revealed 20 adenocarcinoma, 18 adenoid cystic carcinoma, 16 mucoepidermoid carcinoma, 12 primary squamous cell carcinoma, 10 undifferentiated carcinoma, 8 acynic cell carcinoma, 6 ductal cell carcinoma, 3 malignant pleomorphic adenoma, 4 mixed tumor, 3 sarcoma, 6 other. 94 patients underwent surgery with a curative intent: conservative parotidectomy, preserving the main trunk of the facial nerve, was performed in 64 patients, 9 patients had a radical parotidectomy sacrificing the facial nerve, the remaining patients had conservative resections (19) or other forms of surgery; 5 were not operated. Positive surgical margins were documented in 3 cases. There were 30 neck dissections with 27 pathologically positive cases. 10 patients were treated with RT alone. Surgery was supplemented by RT in 98 patients. Total RT doses ranged between 18 Gy to 72 Gy (median: 54 Gy) with dose per fraction of 1.8-3.0 Gy (median: 1.8 Gy), delivered with different techniques. Results: Acute severe toxicity (grade Ill-IV) was reported in 13 patients; chronic sequelae impairing daily activities (grade I1-111)in 18. Locoregionai recurrences occurred in 16 patients. Distant metastases were documented in ten patients all between 14 and 24 months after surgery. The median follow-up is of 36 months (range: 8-120 months).
Conclusions: Postoperative irradiation is indicated for patients with stage III and IV disease, or with earlier stages but affected by histologies at high risk of recurrence, for patients with positive excision margins, and for patients with lymph node metastases. The addition of RT to surgery in high-risk patients can improve Iocoregional control. A substantial number of patients can suffer of acute or late toxicities and develop distant metastases. 213 poster SYNCHRONOUS CHEMOTHERAPY AND HYPOFRACTIONATED ACCELERATED RADIOTHERAPY FOR LOCALLY ADVANCED SQUAMOUS CELL CARCINOMAS OF THE HEAD AND NECK R Sanghera ~, C. McConkey2,K.F. Ho 1, J. Glaholm 1, A. Hartley~ ~QUEENEUZABETHHOSPITAL,Cancer Centre, Birmingham, UK, 2WARWICKMEDICALSCHOOL,Clinical Trials Unit, Warwick, UK
Purpose/Objective: Altered fractionation, and/or addition of chemotherapy, can improve local control rates in locally advanced head and neck cancer. Accelerated schedules reduce the effect of repopulation. The purpose of this study is to determine the local control rates when using a combination of accelerated hypofractionation with outpatient based chemotherapy. Materials/Methods: A retrospective analysis was performed on patients with squamous cell cancer of the larynx, oropharynx, oral cavity and hypopharynx (UICC stage II-IV) receiving 55Gy in 20 fractions with chemotherapy between 1st January 1998 and 1st April 2005. Only patients with a minimum follow up of 12 months were included. Two different single agent chemotherapy schedules were used: carboplatin and methotrexate administered on an outpatient basis.The Kaplan-Meier method was used to determine overall survival (OS), local control (LC) and disease free survival (DFS). Results: Data on the first 81 patients is given. Median follow up was 24 months. Complete response, defined by the absence of local disease at 3 months, was seen in 75 patients (92.6%). The two year OS was 71.6% (95% confidence interval 61.5 to 81.8%). The two year DFS was 68.6% (95% confidence interval 58.4 to 78.8%). The local control rate at two years was 75.4% (95% confidence interval 65.6 to 85.1%). When considering only T3/T4 tumours the two year LC was 64.2% (95% confidence interval 49.3 to 79.0%), OS 59.5% (95% confidence interval 44.2 to 74.8%) and DFS 56.5% (95% confidence interval 41.6 to 71.4%). Conclusions: Accelerated hypofractionated radiotherapy combined with synchronous outpatient chemotherapy achieves a high tumour control rate while being resource efficient and should be the subject of prospective evaluation in comparison with conventionally fractionated chemoradiotherapy schedules. An updated analysis will be presented with comparison of outcome against the leading published prospective studies. 214 poster THE EFFICACY OF INDUCTION CHEMOTHERAPY FOLLOWED BY CONVENTIONAL RADIOTHERAPY AND ADJUVANT THERAPY FOR LOCALLY ADVANCED CARCINOMA OF OROPHARYNX V. Sokurenko CENTRALINSTITUTEOFRADIOLOGY,Radiology, St. Petersburg, Russia
Purpose/Objective: The aim of this study was to evaluated the efficacy and toxicity of a chemoradiotherapy using induction and adjuvant regime chemotherapy in patient with locally advanced squamous cell carcinoma of oropharynx. Materials/Methods: Between 1999 and 2005 years 55 patients with stage II - IY Mo carcinoma of oropharynx were enrolled in a study of Induction Chemotherapy (IC) followed by Radiotherapy (RT) and Adjuvant chemotherapy. Patients initially received IC with 2 - 3 cycles of a Carboplatin 300 mg/m 2 IV over 1 hours infusion plus 5-Fluorouracil 1000 mg/m 2continuous infusion over 96-hours. The
Posters improve storage and interchanging patient information as well as to simplify the access to these data for research purpose. Materials/Methods: SPIDER-H&N (System for Patient Individual Data Entry and Recording in Otolaryngology) is a system based on integrated palm technology, through Intra-lnternet connection, used in our Center to facilitate data recording, archiving, managing and sharing of patients with H&N cancer. This software is able to store all data of those patients who are candidated to any multi-modality treatment. Results: From February 2006, more than 200 patients affected by H&N cancer and treated in our Institution were recorded until now. The system can monitor and trace the various aspects of the clinical management: dates and settings of predicted medical examinations, concomitant or sequential chemotherapy, according to a schedule of treatment chosen by the multidisciplinary team for each patient, response evaluation, timing of surgery and follow-up appointments. Spider-ORL is also able to interact with the hospital system of patient database to capture any information relative to the patient hospitalization and accessible via intranet (identifying, laboratory data, radiological imaging, surgery description, pathology results). All these data are transferred into an electronic archive which can be shared and updated online by all the specialists, even through palm-PC and wireless technology. These data are so available in real time to the single specialist and readable through statistical analysis packages for research purpose. Conclusions: Easing the communication and exchange of clinical informations and data among the specialties involved in patient treatment is nowadays mandatory to optimize data collection, ameliorate the treatment, and therefore improve the outcome of patients. Spider-ORL proved to be a very useful tool in capturing information where it is generated, allowing to overcome the presence of multiple places, times and archiving data modalities, characteristic of any multidisciplinary treatment. 210 poster STAGED NECK DISSECTION (ND) PRE- OR POST-CHEMORADIOTHERAPY (CRT) IS ASSOCIATED WITH IMPROVED DISEASE-FREE SURVIVAL (DFS) BUT NOT OVERALL SURVIVAL (OS) IN LOCALLY ADVANCED OROPHARYNGEAL SQUAMOUS CELL CARCINOMA (OPHSCC)- 20-YEAR EXPERIENCE FROM A SINGLE CENT A, Kirby, M. O'Connell GUY'SANDST. THOMAS'NHS FOUNDATIONTRUST,Clinical Oncology, London,
UK Purpose/Objective: The role and timing of ND in the management of locally advanced OPhSCC remains controversial. There are no prospective randomised controlled trials. We present 20-year results defining the effect of ND upon DFS, OS and complications. Materials/Methods: 312 patients with OPhSCC treated with CRT between 1985 and 2006 were reviewed. There were 240 males and 69 females of mean age 59 years (range 38-90). Tumour sites included tonsil 174; tongue base 87; soft palate 28; posterior pharyngeal wall 12; unspecified 11. 268 had advanced disease (stage III 31, stage IV 237). 231 were treated with radical intent. ND was performed in 88 patients pre-CRT and in 18 patients post-CRT. 125 patients were treated with CRT alone. Median follow-up was 21 months (range 1-207). Results: CRT alone S-year DFS and OS were 50% and 53% respectively. 34/125 (27%) recurred locally: 8 were salvaged, 6 with surgery, and 2 with surgery & brachytherapy. 26 died with local recurrence. 6/125 (5%) died of distant metastatic disease. 3 died of other causes. Complications included fatal neutropenic sepsis (1), radiation myelitis (1), tracheocutaneous fistula (1). 6 patients were PEG-dependent for ~12 months, 4 for ~24 months. ND
5-year DFS and OS were 61% and 55% respectively. Of 41 patients treated with pre-CRT ND, 15% recurred locally and had positive margins + extra-capsular spread. 4 died and 2 were surgically salvaged. 5% died of distant metastases. 1 patient died immediately post-operatively of a CVA. 1 refused CRT and died of local progression. 5/41 (12%) patients were PEG-dependent 712 months, 3 for ~24 months. 2 patients had delayed wound healing and one persistent severe shoulder pain. Of the 18 patients treated with post-CRT ND, 2 (11%) recurred locally and died, one having positive ND margins. 1 patient died of distant metastases. 1 patient died of NSCLC and 1 of unknown cause. 1 patient suffered a prolonged wound infection. 6% were PEG-dependent 712 months. Comparison between the CRT-alone and ND groups using the logrank test shows significantly improved DFS (p=0.04) for staged ND but not OS (p=0.189). Clinical/radiological findings post-CRT ND 15/18 had residual palpable LNs at completion of CRT: residual disease was confirmed on cytology in 2; 1 had false-positive PET scan at 3 months but negative pathology subsequently. Conclusions: Staged ND has significantly increased 5-year DFS (61% vs 50%, p=0.04) but not OS (55% vs 53%, p=0.189). Staged ND prior to CRT is associated with prolonged dysphagia & delayed wound healing. Clincal trials are underway to assess whether FDG-PET postCRT is a better predictor of who needs ND than clinical/CT findings. 211 poster SUBJECTIVE AND OBJECTIVE EVALUATION OF XEROSTOMIA AFTER INTENSITY MODULATED RADIATION THERAPY (IMRT) OF NASOPHARYNGEAL CANCER: PRELIMINARY RESULTS. L. MaruccF, S. MarzP, G. Giovinazzo~,M. Benassi ~,M. 8enassi2,G. Arcangeli ~ 1REGINAELENA~Radiation Oncology, Rome, Italy, 2REGINAELENA,Medical Physics, Rome, Italy
Purpose/Objective: Xerostomia is a common side effect that impairs the quality of life of patients treated with radiotherapy for nasopharyngeal cancer. IMRT, with high dose gradients, offers the opportunity for delivering high doses with optimal target coverage and concurrent sparing of organs at risk such as the parotids. The purpose of this study is to prospectively evaluate subjectively, using a questionnaire, and objectively, measuring the un-stimulated and stimulated salivary flux, xerostomia in patients treated with IMRT for nasopharyngeal cancer. Materials/Methods: In our Department, IMRT has been used to treat NPC since March 2003. A total of 3S patients have been treated until April 2006:14 patients with stage I-II, and 21 with stage Ill-IV disease. Chemotherapy with Cisplatinum was used in all but 4 patients. The median total planned dose was 70 Gy (range 70-74 Gy) in 33-35 fractions for the macroscopic disease (primary and lymph nodes), 60 Gy in 33 fractions for node echelons at high risk of microscopic spread and 54 Gy in 33 fractions for those at intermediate risk. All the patients answered a questionnaire evaluating the functions that are impaired by the lack of saliva. In particular, the general comfort of the oral cavity, chewing, swallowing, tasting, speaking, sleeping and the need to continuously sip water were evaluated. At the same time the flux of saliva at rest and stimulated by chewing was measured. The xerostomia evaluation was done prior to therapy and repeated after 3, 6, 12, 18, 24 months. Results: 30 patients with a median follow up of 20 months (range 6-35) were included in this preliminary analysis. The mean parotid glands dose was 34,3 Gy. None of the patients experienced recurrence at the primary or neck side. At three months after the completion of radiotherapy the majority of patients experienced severe xerostomia and consequently a very impaired quality of life. A significant improvement occurred in the following evaluations in all the parameters considered. The greatest recovery occurred between
$78 -
Posters 6 and 18 months. At 18 months the mean value of un-stimulated and stimulated saliva flux returned to 28% and 55% of baseline, respectively. The improvement in xerostomia was also reflected in a significant improvement in the questionnaire score. The recovery in sleeping and tasting were the most pronounced. Upon multivariate analysis, the question evaluating the general comfort of the mouth was the one with the strongest correlation with the salivary flux. Conclusions: IMRT in early and locally advanced nasopharyngeal cancer permits a decrease in dose to the parotid glands without compromising local control. Such dose reduction is important because it allows the parotid glands to significantly recover their function in time, mainly between 6 and 18 months after the completion of therapy, with a consequent significant improvement of all the function impaired by xerostomia and consequently in the patients quality of life. 212 poster SURGERYAND RADIOTHERAPYINTHETREATMENTOF MALIGNANT PAROTIDTUMORS: A RETROSPECTIVEMULTICENTERSTUDY M. Amichetti~,M. NagliatF, A. Bolner2,V.Vanoni 2,L.Tomio2,GC. Lay3,R. Murtas 3,MA. Deidda3, A. Madeddu4,E. Delmastro4, R.Verna4,P. Gabriele4 1PROTONTHERAPYPROVINCIALAGENCY,dept, Trento, Italy, 20SPEDALESANTACHIARA~Department of Radiation Oncology, Trento,
Italy, 30SPEDALEONCOLOGIco-A.BUSlNCO,Department of Radiation Oncology,
Cagfiari, Italy, 4INSTITUTEOF CANCERRESEARCH,Department of Radiation Oncology, Can-
diolo-Torino, Italy Purpose/Objective: Salivary gland carcinomas are a rare and clinically diverse group of neoplasms. The optimal management of malignant parotid gland tumours remains to be defined precisely. Usually, the combination of surgery (parotidectomy) and radiation therap (RT) is considered the treatment of choice, being radiation therapy alone reserved for palliation or definitive treatment of inoperable lesions. A retrospective, multicenter study was conducted to review the results of the treatment of malignant parotid tumors analyzing patterns of treatment failure and clinical outcomes. Materials/Methods: A retrospective chart review of clinical and pathologic data of the patients treated for malignant parotid tumors at three institutions (Trento, Cagliari, and Candiolo-Torino) from 1993 to 2004 was made.There were 111 patients aged between 22 and 95 years (median age: 66 years); 61 cases were males and 44. females. Six patients with non-Hodgkin's lymphoma were excluded from the analysis. Pathology files of the remaining 105 evaluable cases revealed 20 adenocarcinoma, 18 adenoid cystic carcinoma, 16 mucoepidermoid carcinoma, 12 primary squamous cell carcinoma, 10 undifferentiated carcinoma, 8 acynic cell carcinoma, 6 ductal cell carcinoma, 3 malignant pleomorphic adenoma, 4 mixed tumor, 3 sarcoma, 6 other. 94 patients underwent surgery with a curative intent: conservative parotidectomy, preserving the main trunk of the facial nerve, was performed in 64 patients, 9 patients had a radical parotidectomy sacrificing the facial nerve, the remaining patients had conservative resections (19) or other forms of surgery; 5 were not operated. Positive surgical margins were documented in 3 cases. There were 30 neck dissections with 27 pathologically positive cases. 10 patients were treated with RT alone. Surgery was supplemented by RT in 98 patients. Total RT doses ranged between 18 Gy to 72 Gy (median: 54 Gy) with dose per fraction of 1.8-3.0 Gy (median: 1.8 Gy), delivered with different techniques. Results: Acute severe toxicity (grade Ill-IV) was reported in 13 patients; chronic sequelae impairing daily activities (grade I1-111)in 18. Locoregionai recurrences occurred in 16 patients. Distant metastases were documented in ten patients all between 14 and 24 months after surgery. The median follow-up is of 36 months (range: 8-120 months).
Conclusions: Postoperative irradiation is indicated for patients with stage III and IV disease, or with earlier stages but affected by histologies at high risk of recurrence, for patients with positive excision margins, and for patients with lymph node metastases. The addition of RT to surgery in high-risk patients can improve Iocoregional control. A substantial number of patients can suffer of acute or late toxicities and develop distant metastases. 213 poster SYNCHRONOUS CHEMOTHERAPY AND HYPOFRACTIONATED ACCELERATED RADIOTHERAPY FOR LOCALLY ADVANCED SQUAMOUS CELL CARCINOMAS OF THE HEAD AND NECK R Sanghera ~, C. McConkey2,K.F. Ho 1, J. Glaholm 1, A. Hartley~ ~QUEENEUZABETHHOSPITAL,Cancer Centre, Birmingham, UK, 2WARWICKMEDICALSCHOOL,Clinical Trials Unit, Warwick, UK
Purpose/Objective: Altered fractionation, and/or addition of chemotherapy, can improve local control rates in locally advanced head and neck cancer. Accelerated schedules reduce the effect of repopulation. The purpose of this study is to determine the local control rates when using a combination of accelerated hypofractionation with outpatient based chemotherapy. Materials/Methods: A retrospective analysis was performed on patients with squamous cell cancer of the larynx, oropharynx, oral cavity and hypopharynx (UICC stage II-IV) receiving 55Gy in 20 fractions with chemotherapy between 1st January 1998 and 1st April 2005. Only patients with a minimum follow up of 12 months were included. Two different single agent chemotherapy schedules were used: carboplatin and methotrexate administered on an outpatient basis.The Kaplan-Meier method was used to determine overall survival (OS), local control (LC) and disease free survival (DFS). Results: Data on the first 81 patients is given. Median follow up was 24 months. Complete response, defined by the absence of local disease at 3 months, was seen in 75 patients (92.6%). The two year OS was 71.6% (95% confidence interval 61.5 to 81.8%). The two year DFS was 68.6% (95% confidence interval 58.4 to 78.8%). The local control rate at two years was 75.4% (95% confidence interval 65.6 to 85.1%). When considering only T3/T4 tumours the two year LC was 64.2% (95% confidence interval 49.3 to 79.0%), OS 59.5% (95% confidence interval 44.2 to 74.8%) and DFS 56.5% (95% confidence interval 41.6 to 71.4%). Conclusions: Accelerated hypofractionated radiotherapy combined with synchronous outpatient chemotherapy achieves a high tumour control rate while being resource efficient and should be the subject of prospective evaluation in comparison with conventionally fractionated chemoradiotherapy schedules. An updated analysis will be presented with comparison of outcome against the leading published prospective studies. 214 poster THE EFFICACY OF INDUCTION CHEMOTHERAPY FOLLOWED BY CONVENTIONAL RADIOTHERAPY AND ADJUVANT THERAPY FOR LOCALLY ADVANCED CARCINOMA OF OROPHARYNX V. Sokurenko CENTRALINSTITUTEOFRADIOLOGY,Radiology, St. Petersburg, Russia
Purpose/Objective: The aim of this study was to evaluated the efficacy and toxicity of a chemoradiotherapy using induction and adjuvant regime chemotherapy in patient with locally advanced squamous cell carcinoma of oropharynx. Materials/Methods: Between 1999 and 2005 years 55 patients with stage II - IY Mo carcinoma of oropharynx were enrolled in a study of Induction Chemotherapy (IC) followed by Radiotherapy (RT) and Adjuvant chemotherapy. Patients initially received IC with 2 - 3 cycles of a Carboplatin 300 mg/m 2 IV over 1 hours infusion plus 5-Fluorouracil 1000 mg/m 2continuous infusion over 96-hours. The