- Email: [email protected]
AJCC Staging System for Nasopharyngeal Carcinoma Based on Intensity Modulated Radiation Therapy
Poster Viewing E357
Volume 96 Number 2S Supplement 2016 Purpose/Objective(s): pT1-2No oral cavity squamous cell carcinoma is considered to be early stage cancer. NCCN 2015 does not recommend the use of postoperative adjuvant radiation therapy in OSCC patients with pT1-2N0 disease. However, it has already been proved in various studies that oral tongue squamous cell cancer behaves aggressively and has poor prognosis as compared to other sites of oral cavity. This is a retrospective analysis of pT1-2N0 oral tongue cancer Indian patients. The aim was to study the outcomes of adjuvant radiation therapy in the form of 5 year local control, neck control and DFS. The secondary aim was to identify the potential prognostic factors affecting the outcomes. Materials/Methods: 166 patients with pT1-2N0 oral tongue cancer treated at our institute from 2007 to 2011 were included in the study. All the patients had undergone surgery in the form of hemiglossectomy with neck node dissection. 128 patients had received post op adjuvant radiation therapy (dose 60 Gy/30fr) and 38 patients were kept on observation. 19 patients had no follow up, 6 patients could only be followed up to 2 years and 3 patients died before 5 years due to non-malignant cause. So these patients were excluded and the final analysis was done on 139 patients. Results: The 5 year rates in the group given post op RT were as follows: local control 86%, neck control 94%, no distant metastasis while in the observation group, local control 85%, neck control 76%, and no distant metastasis. Comparing both the groups, the 5 year DFS was 74% and 52.9% in the patients who received post op adjuvant RT and those kept on observation respectively. Depth of invasion (P Z 0.002) and grade of tumor (P Z 0.00) were significant prognostic factors proven both by univariate and multivariate analysis. Conclusion: Post op radiation therapy should be considered in pT1-2N0 oral tongue cancer patients with depth of invasion >4mm and high grade tumors. First chance is the best chance to cure the patient. Observation is not a feasible option in India where patients cannot be kept on strict follow up. Author Disclosure: S. Gupta: None. J. Bhattacharya: None. K. Patel: None. P. Aggarwal: None. U. Suryanaryana: None.
2880 Suggestions for Future Improvements of the Seventh Edition of the UICC/AJCC Staging System for Nasopharyngeal Carcinoma Based on Intensity Modulated Radiation Therapy Y. Mao,1 L. Gao,2 Y. SUN,1 J.L. Yi,2 and J. Ma1; 1Sun Yat-sen University Cancer Center, Guangzhou, China, 2Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China Purpose/Objective(s): This study aimed to evaluate the 7th edition of the International Union against Cancer/ American Joint Committee on Cancer staging system for nasopharyngeal cancer (NPC) in patients treated with intensity-modulated radiation therapy (IMRT) and to provide suggestions for future revision. Materials/Methods: We retrospectively reviewed a total of 986 magneticresonance-imaging staged patients with non-metastatic NPC treated using IMRT at Sun Yat-sen University Cancer Center (South China; n Z 749) and Chinese Academy of Medical Sciences Cancer Institute (North China; n Z 237) between January 2003 and December 2008. Results: Using the 7th edition, disease-free survival (DFS) were not significantly different in T2 and T3. Merging T2 and T3 into T2 resulted in improved prognostication in local relapse-free survival and DFS (P < 0.046). Distant metastasis-free survival and DFS showed well segregations between adjacent N-categories, except for insignificant differences between N3a and N2, N3a and N3b (P > 0.133). Greatest dimension was still an independent factor in multivariate analysis. We suggest to merge nodes>6cm (current N3a) and/or extension into supraclavicular fossa (current N3b) as N3. Merging T2 and T3, N3a and N3b, and defining T1N0 as stage I; T2N0, T1N1 and T2N1 as stage II; T3N0, T3N1, T3N2, T1N2 and T2N2 as stage III, and T1N3, T2N3, and T3N3 as stage IV resulted in an orderly increase in disease failure hazard ratios, improved hazard consistency amongst stage subgroups and provided acceptable stage distribution.
Conclusion: The proposed system could enable more accurate prognostication and provide useful suggestions for future revision of the TNM system, and provides useful suggestions for future revision of the TNM system. Author Disclosure: Y. Mao: None. L. Gao: None. Y. SUN: None. J. Yi: None. J. Ma: None.
2881 CNS Dose Is Not Associated With Treatment-Related Fatigue in Patients Undergoing Radiation Therapy for Head and Neck Cancer M.J. Ferris,1 J. Zhong,2 J. Switchenko,3 K.A. Higgins,1 M.W. McDonald,1 B.R. Eaton,4 A.H. Miller,5 D. Watkins Bruner,6 C. Xiao,6 and J.J. Beitler1; 1 Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, GA, 2Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 3Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA, 4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 5Department of Psychiatry and Behavioral Sciences, Winship Cancer Institute at Emory University, Atlanta, GA, 6Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute at Emory University, Atlanta, GA Purpose/Objective(s): Dose to central nervous system (CNS) structures has been implicated as a contributor to treatment-related fatigue experienced by head and neck cancer patients undergoing intensity modulated radiation therapy (IMRT). This study evaluates the correlation of dose to CNS structures with prospectively-collected patient-reported assessments of fatigue in this patient population. Materials/Methods: Prospectively-gathered fatigue data obtained at preRT and one-month post-RT time points via the Multidimensional Fatigue Inventory (MFI)-20, a validated metric, was available for 54 patients. Retrospective delineation of the brainstem, cerebellum, and whole brain was performed. Dosimetry was reviewed using summary statistics and dose-volume atlases. Correlation between CNS structure dosimetry and patient fatigue scores was statistically analyzed. Results: Primary sites were distributed as: oropharynx (30 patients), oral cavity (9), nasal cavity/paranasal sinus (5), larynx (5), nasopharynx (2), hypopharynx (2), unknown (1). Cerebellum maximum dose (P Z 0.650), cerebellum mean dose (P Z 0.367), whole brain mean dose (P Z 0.205), and dose-volume relationships corresponding to the cerebellum were not associated with higher rates of fatigue at one-month post-RT. Patients who received higher maximum dose (P Z 0.015) and higher mean dose (P Z 0.010) to the brainstem had significantly higher fatigue scores at onemonth post-RT, but this relationship did not persist when controlling for pre-RT fatigue scores. For the brainstem, dose-volume relationships up to 15 Gy (percent brainstem volume receiving each integer dose from 2-14 Gy) were significantly associated with total fatigue score at one-month post-RT, but again, the relationship did not persist when controlling for pre-RT fatigue scores. No relationship was found between brainstem dose and either absolute or relative change in fatigue scores. Conclusion: Dose to the brainstem, cerebellum, and whole brain were not independently associated with greater fatigue in patients undergoing RT for treatment of head and neck cancer. To our knowledge, this study is the first of its kind correlating CNS structure dosimetry to a patient-reported assessment of fatigue. Fatigue in head and neck cancer radiation patients is clearly multifactorial, and it seems unlikely that constraining dose to the CNS would show benefit. Author Disclosure: M.J. Ferris: None. J. Zhong: None. J. Switchenko: None. K.A. Higgins: None. M.W. McDonald: None. B.R. Eaton: None. A.H. Miller: None. D. Watkins Bruner: None. C. Xiao: None. J.J. Beitler: None.
2882 Can Parameters Other Than Minimal Axial Diameter in MRI and PET/ CT Further Improve the Diagnostic Accuracy of Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma? Y.W. Wang,1,2 K.R. Lin,2 C.H. Chang,3 K.S. Cheng,3 and W.J. Yao4; 1Chi Mei Medical Center Liouying, Tainan, Taiwan, 2Institute of Biomedical
Volume 96 Number 2S Supplement 2016 Purpose/Objective(s): pT1-2No oral cavity squamous cell carcinoma is considered to be early stage cancer. NCCN 2015 does not recommend the use of postoperative adjuvant radiation therapy in OSCC patients with pT1-2N0 disease. However, it has already been proved in various studies that oral tongue squamous cell cancer behaves aggressively and has poor prognosis as compared to other sites of oral cavity. This is a retrospective analysis of pT1-2N0 oral tongue cancer Indian patients. The aim was to study the outcomes of adjuvant radiation therapy in the form of 5 year local control, neck control and DFS. The secondary aim was to identify the potential prognostic factors affecting the outcomes. Materials/Methods: 166 patients with pT1-2N0 oral tongue cancer treated at our institute from 2007 to 2011 were included in the study. All the patients had undergone surgery in the form of hemiglossectomy with neck node dissection. 128 patients had received post op adjuvant radiation therapy (dose 60 Gy/30fr) and 38 patients were kept on observation. 19 patients had no follow up, 6 patients could only be followed up to 2 years and 3 patients died before 5 years due to non-malignant cause. So these patients were excluded and the final analysis was done on 139 patients. Results: The 5 year rates in the group given post op RT were as follows: local control 86%, neck control 94%, no distant metastasis while in the observation group, local control 85%, neck control 76%, and no distant metastasis. Comparing both the groups, the 5 year DFS was 74% and 52.9% in the patients who received post op adjuvant RT and those kept on observation respectively. Depth of invasion (P Z 0.002) and grade of tumor (P Z 0.00) were significant prognostic factors proven both by univariate and multivariate analysis. Conclusion: Post op radiation therapy should be considered in pT1-2N0 oral tongue cancer patients with depth of invasion >4mm and high grade tumors. First chance is the best chance to cure the patient. Observation is not a feasible option in India where patients cannot be kept on strict follow up. Author Disclosure: S. Gupta: None. J. Bhattacharya: None. K. Patel: None. P. Aggarwal: None. U. Suryanaryana: None.
2880 Suggestions for Future Improvements of the Seventh Edition of the UICC/AJCC Staging System for Nasopharyngeal Carcinoma Based on Intensity Modulated Radiation Therapy Y. Mao,1 L. Gao,2 Y. SUN,1 J.L. Yi,2 and J. Ma1; 1Sun Yat-sen University Cancer Center, Guangzhou, China, 2Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China Purpose/Objective(s): This study aimed to evaluate the 7th edition of the International Union against Cancer/ American Joint Committee on Cancer staging system for nasopharyngeal cancer (NPC) in patients treated with intensity-modulated radiation therapy (IMRT) and to provide suggestions for future revision. Materials/Methods: We retrospectively reviewed a total of 986 magneticresonance-imaging staged patients with non-metastatic NPC treated using IMRT at Sun Yat-sen University Cancer Center (South China; n Z 749) and Chinese Academy of Medical Sciences Cancer Institute (North China; n Z 237) between January 2003 and December 2008. Results: Using the 7th edition, disease-free survival (DFS) were not significantly different in T2 and T3. Merging T2 and T3 into T2 resulted in improved prognostication in local relapse-free survival and DFS (P < 0.046). Distant metastasis-free survival and DFS showed well segregations between adjacent N-categories, except for insignificant differences between N3a and N2, N3a and N3b (P > 0.133). Greatest dimension was still an independent factor in multivariate analysis. We suggest to merge nodes>6cm (current N3a) and/or extension into supraclavicular fossa (current N3b) as N3. Merging T2 and T3, N3a and N3b, and defining T1N0 as stage I; T2N0, T1N1 and T2N1 as stage II; T3N0, T3N1, T3N2, T1N2 and T2N2 as stage III, and T1N3, T2N3, and T3N3 as stage IV resulted in an orderly increase in disease failure hazard ratios, improved hazard consistency amongst stage subgroups and provided acceptable stage distribution.
Conclusion: The proposed system could enable more accurate prognostication and provide useful suggestions for future revision of the TNM system, and provides useful suggestions for future revision of the TNM system. Author Disclosure: Y. Mao: None. L. Gao: None. Y. SUN: None. J. Yi: None. J. Ma: None.
2881 CNS Dose Is Not Associated With Treatment-Related Fatigue in Patients Undergoing Radiation Therapy for Head and Neck Cancer M.J. Ferris,1 J. Zhong,2 J. Switchenko,3 K.A. Higgins,1 M.W. McDonald,1 B.R. Eaton,4 A.H. Miller,5 D. Watkins Bruner,6 C. Xiao,6 and J.J. Beitler1; 1 Department of Radiation Oncology, Winship Cancer Institute at Emory University, Atlanta, GA, 2Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 3Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA, 4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 5Department of Psychiatry and Behavioral Sciences, Winship Cancer Institute at Emory University, Atlanta, GA, 6Nell Hodgson Woodruff School of Nursing, Winship Cancer Institute at Emory University, Atlanta, GA Purpose/Objective(s): Dose to central nervous system (CNS) structures has been implicated as a contributor to treatment-related fatigue experienced by head and neck cancer patients undergoing intensity modulated radiation therapy (IMRT). This study evaluates the correlation of dose to CNS structures with prospectively-collected patient-reported assessments of fatigue in this patient population. Materials/Methods: Prospectively-gathered fatigue data obtained at preRT and one-month post-RT time points via the Multidimensional Fatigue Inventory (MFI)-20, a validated metric, was available for 54 patients. Retrospective delineation of the brainstem, cerebellum, and whole brain was performed. Dosimetry was reviewed using summary statistics and dose-volume atlases. Correlation between CNS structure dosimetry and patient fatigue scores was statistically analyzed. Results: Primary sites were distributed as: oropharynx (30 patients), oral cavity (9), nasal cavity/paranasal sinus (5), larynx (5), nasopharynx (2), hypopharynx (2), unknown (1). Cerebellum maximum dose (P Z 0.650), cerebellum mean dose (P Z 0.367), whole brain mean dose (P Z 0.205), and dose-volume relationships corresponding to the cerebellum were not associated with higher rates of fatigue at one-month post-RT. Patients who received higher maximum dose (P Z 0.015) and higher mean dose (P Z 0.010) to the brainstem had significantly higher fatigue scores at onemonth post-RT, but this relationship did not persist when controlling for pre-RT fatigue scores. For the brainstem, dose-volume relationships up to 15 Gy (percent brainstem volume receiving each integer dose from 2-14 Gy) were significantly associated with total fatigue score at one-month post-RT, but again, the relationship did not persist when controlling for pre-RT fatigue scores. No relationship was found between brainstem dose and either absolute or relative change in fatigue scores. Conclusion: Dose to the brainstem, cerebellum, and whole brain were not independently associated with greater fatigue in patients undergoing RT for treatment of head and neck cancer. To our knowledge, this study is the first of its kind correlating CNS structure dosimetry to a patient-reported assessment of fatigue. Fatigue in head and neck cancer radiation patients is clearly multifactorial, and it seems unlikely that constraining dose to the CNS would show benefit. Author Disclosure: M.J. Ferris: None. J. Zhong: None. J. Switchenko: None. K.A. Higgins: None. M.W. McDonald: None. B.R. Eaton: None. A.H. Miller: None. D. Watkins Bruner: None. C. Xiao: None. J.J. Beitler: None.
2882 Can Parameters Other Than Minimal Axial Diameter in MRI and PET/ CT Further Improve the Diagnostic Accuracy of Equivocal Retropharyngeal Lymph Nodes in Nasopharyngeal Carcinoma? Y.W. Wang,1,2 K.R. Lin,2 C.H. Chang,3 K.S. Cheng,3 and W.J. Yao4; 1Chi Mei Medical Center Liouying, Tainan, Taiwan, 2Institute of Biomedical