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THE BEHAVIOUR OF ELDERLY PATIENTS TREATED WITH CHEMORADIATION. A SINGLE INSTITUTION EXPERIENCE
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FRIDAY,FEBRUARY 25,201 1 tion of patients with head and neck cancer in relation to age, tumour location, stage and treatment modality. We assessed quality of life association with long-term survival in this group of patients. Materlals: 128 patients with head and neck cancer were evaluated with standardized HRQOL questionnaires, the EORTC QLQCBO and the H&N35. Patients were planned to be treated by different composite resections. In some cases microvascular tissue transfer was performed for the reconstruction of their surgical defects; in the others local flaps or primary closure was performed. Post-operative radiation therapy was performed when indicated in order of stage and surgical margins. Overall survival and odds of death were measured. Results: Highest mean scores, indicating worse impact on well-being, were noted in the domains of speech, social eating, and senses. Dry mouth and sticky saliva both demonstrated high impact on quality of life for patients underwent postoperative radiotherapy. Quality of life impairment was worse in all of the domains for combination therapy versus surgery alone (pc0.005). Tumour location and TNM staging were both significantly associated with each of the quality of life domain scores. Quality of life scores at diagnosis in this cohort of patients were correlated with overall survival. Conclusions: The present analysis represents, to our knowledge, the only study of head and neck cancer patients for whom baseline QOL data were analyzed and correlated with overall survival. Our results provide evidence for a positive relationship between quality of life data, or some aspects of quality of life domains, and the duration of survival in oral cancer patients. Pie-treatment (baseline) quality of life data appeared to provide the most reliable information for helping clinicians to establish prognostic criteria for their cancer patients.lt is recommended that future studies should use this kind of evaluation to understand the real complexity of a disease named oral cancer. As HRQOL field evolves, it should acquire greater clinical importance and expand the lesson we take away from clinical trials.
S 13
Purpose: Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors for the risk for developing swallowing dysfunction are multiple and their interrelationship not well established. The aim of this report was to establish a multivariate predictive model for acute and late dysphagia after RT, based on information from a large prospective trial. Materials: The DAHANCA 6&7 randomized phase-Ill study included 1,476 patients with squamous cell carcinoma of the head and neck eligible for primary RT alone. Patients were randomized between 5 or 6 weekly fractions of conventional RT, and received 66-68 Gy in 33-34 fractions. If non-glottic cancer Nimorazole was administered. Patients were seen weekly during treatment and at regular intervals until 5 years after treatment. Prospective morbidity recording included subjective symptoms and objective physician scores and were available from 1,468 patients. Results: Acute dysphagia according to DAHANCA grades 1, 2, 3 and 4 occurred in 83%, 71%, 43% and 23%, respectively. Severe dysphagia, defined as "liquid food only" or worse (grade 3 or 4) occurred in 47% and 38% of patients receiving accelerated or conventional radiotherapy, respectively (p=O.OOl). At 1,2,3,4 and 5 years, the prevalence of chronic dysphagia greater than grade 0, was 46'7% 32%, 29%, 24%, 23 %, respectively with no difference between 5 and 6 fractionsh a multiple logistic regression analysis, the following factors were significant independent factors for severe acute dysphagia (Table 1): T3-T4 tumors, N-positive, non-glottic cancer, age>62 years, baseline dysphagia > 0 and accelerated radiotherapy.The following factors were prognostic factors for late dysphagia: non-glottic cancer, T3-T4 and baseline dysphagia > 0.
22 oral THE BEHAVIOUR OF ELDERLY PATIENTS TREATED WITH CHEMORADIATION. A SINGLE INSTITUTION EXPERIENCE M. Merlano', E. Russi', I. colantonio', N. Denaro', V. Adamo3, G. numico4, E. miraglio' A S 0 S.CROCEE CARLE,Clinical Oncology, Cuneo, Italy A S 0 S.CROCEE CARLE,Department of Radiation Oncology, Cuneo, Italy UNIVERSITY OF MESSINA,Clinical Oncology, Messina, Italy ASO S.CROCE E CARLE, Cuneo, Italy
' '
Purpose: The MACH-NC showed that elderly patients do not benefit by chemoradiation (CT/RT). Indeed the death risk reduction loses significance by the age of 60 and is not significant over 70. Over the meta-analysis collect data from experimental, multiintitutional clinical trials. Remains unclear the impact of age in the daily clinical practice of an experienced single Institution. We have analyzed the individual patient data collected in our data base to answer this issue Materials: We have analyzed data from 318 pts with LA-SCC-HNC stage Ill-IV, treated with CT/RT between 1997 and 2008. Most of them received alternating CT/RT (Merlano, JNCl 1996; Lefebvre, JNCl 2009). Considering 65 years as the cut-of, we recorded 217 young pts and 101 old. We analyzed toxicity by X2 test and PFS and 0s by log-rank test. Distribution of "young" and "old was similar regardless site of primary and all the major known prognostic factors, including therapy. Results: Hemathological and mucosal toxicity did not differ significantly among the two groups, but a higher proportion of "on-treatment" deaths occurred in elderly pts (8/101vs 6/217; p<0.03). Nutritional support was given more frequently to elderly pts (enteral
'
'
'
1.00
262 years Fractions per week 5 fx per week 6 fx per week Performance status Sex
0.40-0.89
0.01
nr
1.12-2.50
0.004
"5
"S
ns
1.67 1.00 1.77
"S
nr
Conclusions: Predictive models were established to characterize patients who were at risk of developing acute or late dysphagia after RT in the DAHANCA 687 trial. The results may be useful to identify patients who could benefit from, or require, prophylactic measures against swallowing dysfunction. The study has been supported by the Danish Cancer Society. 24 oral
FOR DYSPHAGIA PREDICTIVE MODELS AFTER (CHEM0)RADIATION IN HEAD AND NECK CANCER: A MULTICENTER PROSPECTIVE COHORT STUDY M.Christianen', H. F! Bijl', C. Schilstra', I. Beetz', 0. Chouvalova', R. Steenbakkers', F. Burlage', P. Doornaert2, D. Rietveld', C. R. Leemans3, R. Rinke13, B. F. van der Laan4, I. Verdonck-de Leeuw3, H. Langendijk' UNIVERSITY MEDICALCENTER GRONINGEN / UNIVERSITY OF GRONINGEN, Radiation Oncology, Groningen, Netherlands VU UNIVERSITYMEDICALCENTER,Radiation Oncology, Amsterdam, Netherlands VU UNIVERSITY MEDICAL CENTER, Otolaryngology/Head and Neck Surgery, Amsterdam, Netherlands UNIVERSITY MEDICALCENTER GRONINGEN / UNIVERSITY OF GRONINGEN, OtolaryngologylHead and Neck Surgery, Groningen, Netherlands
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Purpose: Results of clinical studies suggest that dose distributions in the pharyngeal muscles and laryngeal structures are significantly associated with the probability of dysphagia after curative (chemo) radiation ((CH)RT) in head and neck cancer (HNC) patients. The purpose of this multicenter prospective cohort study was to identify which DVH-parameters and other determinants are most important to predict dysphagia at 12, 18 and 24 months after (CH)RT. Materials: The study population was composed of 369 consecutive patients with HNC treated with curative (CH)RT. The primary endpoint was grade 2 or more dysphagia according to the RTOG/EORTC late radiation morbidity scoring criteria at 12 (SWALMlZ), 18 (SWALM18), and 24 months (SWALM24)
FRIDAY,FEBRUARY 25,201 1 tion of patients with head and neck cancer in relation to age, tumour location, stage and treatment modality. We assessed quality of life association with long-term survival in this group of patients. Materlals: 128 patients with head and neck cancer were evaluated with standardized HRQOL questionnaires, the EORTC QLQCBO and the H&N35. Patients were planned to be treated by different composite resections. In some cases microvascular tissue transfer was performed for the reconstruction of their surgical defects; in the others local flaps or primary closure was performed. Post-operative radiation therapy was performed when indicated in order of stage and surgical margins. Overall survival and odds of death were measured. Results: Highest mean scores, indicating worse impact on well-being, were noted in the domains of speech, social eating, and senses. Dry mouth and sticky saliva both demonstrated high impact on quality of life for patients underwent postoperative radiotherapy. Quality of life impairment was worse in all of the domains for combination therapy versus surgery alone (pc0.005). Tumour location and TNM staging were both significantly associated with each of the quality of life domain scores. Quality of life scores at diagnosis in this cohort of patients were correlated with overall survival. Conclusions: The present analysis represents, to our knowledge, the only study of head and neck cancer patients for whom baseline QOL data were analyzed and correlated with overall survival. Our results provide evidence for a positive relationship between quality of life data, or some aspects of quality of life domains, and the duration of survival in oral cancer patients. Pie-treatment (baseline) quality of life data appeared to provide the most reliable information for helping clinicians to establish prognostic criteria for their cancer patients.lt is recommended that future studies should use this kind of evaluation to understand the real complexity of a disease named oral cancer. As HRQOL field evolves, it should acquire greater clinical importance and expand the lesson we take away from clinical trials.
S 13
Purpose: Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors for the risk for developing swallowing dysfunction are multiple and their interrelationship not well established. The aim of this report was to establish a multivariate predictive model for acute and late dysphagia after RT, based on information from a large prospective trial. Materials: The DAHANCA 6&7 randomized phase-Ill study included 1,476 patients with squamous cell carcinoma of the head and neck eligible for primary RT alone. Patients were randomized between 5 or 6 weekly fractions of conventional RT, and received 66-68 Gy in 33-34 fractions. If non-glottic cancer Nimorazole was administered. Patients were seen weekly during treatment and at regular intervals until 5 years after treatment. Prospective morbidity recording included subjective symptoms and objective physician scores and were available from 1,468 patients. Results: Acute dysphagia according to DAHANCA grades 1, 2, 3 and 4 occurred in 83%, 71%, 43% and 23%, respectively. Severe dysphagia, defined as "liquid food only" or worse (grade 3 or 4) occurred in 47% and 38% of patients receiving accelerated or conventional radiotherapy, respectively (p=O.OOl). At 1,2,3,4 and 5 years, the prevalence of chronic dysphagia greater than grade 0, was 46'7% 32%, 29%, 24%, 23 %, respectively with no difference between 5 and 6 fractionsh a multiple logistic regression analysis, the following factors were significant independent factors for severe acute dysphagia (Table 1): T3-T4 tumors, N-positive, non-glottic cancer, age>62 years, baseline dysphagia > 0 and accelerated radiotherapy.The following factors were prognostic factors for late dysphagia: non-glottic cancer, T3-T4 and baseline dysphagia > 0.
22 oral THE BEHAVIOUR OF ELDERLY PATIENTS TREATED WITH CHEMORADIATION. A SINGLE INSTITUTION EXPERIENCE M. Merlano', E. Russi', I. colantonio', N. Denaro', V. Adamo3, G. numico4, E. miraglio' A S 0 S.CROCEE CARLE,Clinical Oncology, Cuneo, Italy A S 0 S.CROCEE CARLE,Department of Radiation Oncology, Cuneo, Italy UNIVERSITY OF MESSINA,Clinical Oncology, Messina, Italy ASO S.CROCE E CARLE, Cuneo, Italy
' '
Purpose: The MACH-NC showed that elderly patients do not benefit by chemoradiation (CT/RT). Indeed the death risk reduction loses significance by the age of 60 and is not significant over 70. Over the meta-analysis collect data from experimental, multiintitutional clinical trials. Remains unclear the impact of age in the daily clinical practice of an experienced single Institution. We have analyzed the individual patient data collected in our data base to answer this issue Materials: We have analyzed data from 318 pts with LA-SCC-HNC stage Ill-IV, treated with CT/RT between 1997 and 2008. Most of them received alternating CT/RT (Merlano, JNCl 1996; Lefebvre, JNCl 2009). Considering 65 years as the cut-of, we recorded 217 young pts and 101 old. We analyzed toxicity by X2 test and PFS and 0s by log-rank test. Distribution of "young" and "old was similar regardless site of primary and all the major known prognostic factors, including therapy. Results: Hemathological and mucosal toxicity did not differ significantly among the two groups, but a higher proportion of "on-treatment" deaths occurred in elderly pts (8/101vs 6/217; p<0.03). Nutritional support was given more frequently to elderly pts (enteral
'
'
'
1.00
262 years Fractions per week 5 fx per week 6 fx per week Performance status Sex
0.40-0.89
0.01
nr
1.12-2.50
0.004
"5
"S
ns
1.67 1.00 1.77
"S
nr
Conclusions: Predictive models were established to characterize patients who were at risk of developing acute or late dysphagia after RT in the DAHANCA 687 trial. The results may be useful to identify patients who could benefit from, or require, prophylactic measures against swallowing dysfunction. The study has been supported by the Danish Cancer Society. 24 oral
FOR DYSPHAGIA PREDICTIVE MODELS AFTER (CHEM0)RADIATION IN HEAD AND NECK CANCER: A MULTICENTER PROSPECTIVE COHORT STUDY M.Christianen', H. F! Bijl', C. Schilstra', I. Beetz', 0. Chouvalova', R. Steenbakkers', F. Burlage', P. Doornaert2, D. Rietveld', C. R. Leemans3, R. Rinke13, B. F. van der Laan4, I. Verdonck-de Leeuw3, H. Langendijk' UNIVERSITY MEDICALCENTER GRONINGEN / UNIVERSITY OF GRONINGEN, Radiation Oncology, Groningen, Netherlands VU UNIVERSITYMEDICALCENTER,Radiation Oncology, Amsterdam, Netherlands VU UNIVERSITY MEDICAL CENTER, Otolaryngology/Head and Neck Surgery, Amsterdam, Netherlands UNIVERSITY MEDICALCENTER GRONINGEN / UNIVERSITY OF GRONINGEN, OtolaryngologylHead and Neck Surgery, Groningen, Netherlands
' '
Purpose: Results of clinical studies suggest that dose distributions in the pharyngeal muscles and laryngeal structures are significantly associated with the probability of dysphagia after curative (chemo) radiation ((CH)RT) in head and neck cancer (HNC) patients. The purpose of this multicenter prospective cohort study was to identify which DVH-parameters and other determinants are most important to predict dysphagia at 12, 18 and 24 months after (CH)RT. Materials: The study population was composed of 369 consecutive patients with HNC treated with curative (CH)RT. The primary endpoint was grade 2 or more dysphagia according to the RTOG/EORTC late radiation morbidity scoring criteria at 12 (SWALMlZ), 18 (SWALM18), and 24 months (SWALM24)