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The Effect of Smoking and Human Papillomavirus Status on Survival in Oropharyngeal Squamous Cell Carcinoma Patients Undergoing Concurrent Chemoradiation
Volume 94 Number 4 2016
Posters
tumor board checklist with review of all newly diagnosed head and neck patients prior to and after implementation. Author Disclosure: W. Swegal: None. S. Chang: None.
179 Dramatic Reduction in the Need for Feeding Tube Use in Human PappilomavirusePositive Oropharyngeal Cancer in the Intensity Modulated Radiation Therapy Era S. Koyfman,1 M.C. Ward,2 N. Houston,2 N.P. Joshi,1 B. Harr,2 T. Nwizu,2 D.J. Adelstein,2 P. Xia,1 and J.F. Greskovich, Jr3; 1Cleveland Clinic Foundation, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH, 3 Cleveland Clinic Florida, Weston, FL Purpose/Objective(s): Human papillomavirus (HPV)-positive oropharyngeal cancer patients have improved cancer-related outcomes and appear to tolerate treatment with less morbidity. We hypothesize that feeding tube rates are decreasing selectively in this population. Materials/Methods: Patients treated with definitive chemoradiation (CRT; >66 Gy) for head and neck squamous cell cancer between 2007 and 2014 were included in this institutional review obardeapproved study. Patients were treated with 3-dimensional CRT in the earlier years of the study and intensity modulated radiation therapy (IMRT) since 2009. All patients were treated with concurrent chemotherapy, typically cisplatin based (90%), or with cetuximab (10%). At our institution, prophylactic feeding tubes (FTs) are typically avoided, and reactive FTs are used if patients lose excessive amounts of weight or experience dehydration requiring admission. Analysis of Variance trend test was performed to identify the significance of temporal trends in the use of FTs over time. Results: Of 421 patients included in this study, 194 (46%) had an FT placed. Of these, corpaks were used in 84%, while percutaneous endoscopic gastrostomy (PEG) tubes were used in the remainder. HPVpositive oropharyngeal cancers comprised 280 pts (66%), while the remainder included pts with cancers of the larynx (15%), HPV-negative oropharynx (11%), hypopharynx (4.5%), and nasopharynx (2.5%). Median age was 58 years, 84% were male, and 76% had a smoking history (median pack-years, 27). Median dose of RT was 72 Gy (68-78 Gy). Rates of FT use steadily declined for patients with HPV-positive oropharynx cancer, with a highly significant decrease from 80% in 2007 to 24% in 2014 (R2Z0.931; PZ.0001). This pattern was not seen for all other (HPV-negative) patients (see Table 1). Median duration of FT use was 60 days and did not differ by HPV status. Overall, only 40 pts (10%) had an FT beyond 90 days following IMRT, and only 15 patients (3.6%) had an FT at last follow-up. Conclusion: FT use has become the exception rather than the rule in patients with HPV-positive oropharyngeal cancer undergoing definitive CRT. Routine FT use should be avoided in this population. Author Disclosure: S. Koyfman: None. M.C. Ward: None. N. Houston: None. N.P. Joshi: None. B. Harr: None. T. Nwizu: None. D.J. Adelstein: None. P. Xia: None. J.F. Greskovich: None.
903
180 Proliferation Saturation Index Predicts Oropharyngeal Squamous Cell Cancer Gross Tumor Volume Reduction to Prospectively Identify Patients for Adaptive Radiation Therapy T. Lewin,1 J. Kim,2 K. Latifi,3 J. Poleszczuk,4 J. Bull,1 H. Byrne,1 J.F. Torres-Roca,3 E.G. Moros,3 R. Gatenby,2 L.B. Harrison,3 J. Heukelom,5 A.S.R. Mohamed,6 D.I. Rosenthal,6 C.D. Fuller,6 J.J. Caudell,3 and H. Enderling4; 1University of Oxford, Oxford, United Kingdom, 2H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 3 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 4 H. Lee Moffitt Cancer Center, Tampa, FL, 5Netherlands Cancer Institute, Amsterdam, Netherlands, 6The University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): Radiation therapy (RT) for human papillomavirus (HPV)-positive oropharyngeal squamous cell cancer (OPX) provides 3year locoregional control (LRC) rates of 75% to 95%. Given the excellent cancer control outcomes for OPX following RT, there is significant interest in reducing therapy intensity, such as adaptive radiation therapy (ART), for rapidly shrinking tumor volumes to improve organ at risk sparing. However, we have limited understanding of which patients will be suitable for ART. Proliferation saturation index (PSI) is defined as a ratio of tumor volume to host tissue carrying capacity. Tissue carrying capacity (K) is an integral measure of the maximum tumor volume that can be supported by the current tumor environment including oxygen and nutrient availability, immune surveillance, and acidity. The PSI can be measured from 2 pretreatment computed tomographic (CT) scans separated in time. We hypothesized that PSI may be able to define a subgroup of patients with rapidly shrinking tumors during RT who may gain the most benefit from ART. Materials/Methods: From an MDACC institutional database, 9 patients with OPX treated with RT and concurrent chemotherapy were identified. Patient demographics, treatment, and outcomes were extracted. PSI was estimated from routine pre-RT and RT planning simulation computer tomography scans and the Gompertz tumor growth model. Gross tumor volume (GTV) was contoured on weekly CT scans obtained during treatment to estimate tumor shrinkage. GTV reductions during fractionated RT were calculated as a function of PSI. Results: Gompertz tumor growth with patient-specific PSI values fit retrospective data with high confidence (R2>0.93). Median PSI was 0.1 (range 0.01-0.3). Median GTV was 23.6 cm3 (range 3.5-62). Of the 9 patients, 3 had GTV reductions of >20% within the first 3 weeks. This was correlated with PSI values less than 0.07. Conclusion: PSI derived from standard of care CT images may be able to prospectively identify candidates for ART prior to treatment. Author Disclosure: T. Lewin: None. J. Kim: None. K. Latifi: None. J. Poleszczuk: None. J. Bull: None. H. Byrne: None. J.F. Torres-Roca: None. E.G. Moros: None. R. Gatenby: None. L.B. Harrison: None. J. Heukelom: None. A.S. Mohamed: None. D.I. Rosenthal: None. C.D. Fuller: None. J.J. Caudell: None. H. Enderling: None.
181 Abstract 179; Table 1 Year
HPV+ oropharynx feeding tube
All other feeding tube
2007 2008 2009 2010 2011 2012 2013 2014
80% 59.25% 53.33% 54% 29.26% 41.86% 25% 23.91%
34.37% 24.24% 32.43% 52.94% 61.53% 46.66% 38.46% 21.87%
The Effect of Smoking and Human Papillomavirus Status on Survival in Oropharyngeal Squamous Cell Carcinoma Patients Undergoing Concurrent Chemoradiation A. Platek,1 V. Jakaprakash,1 M. Platek,2 V. Gupta,1 D. Cohan,1 W. Hicks,1 T. Winslow,3 A. Groman,4 S.S. Dibaj,1 H. Arshad,1 M.A. Kuriakose,1 G.W. Warren,5 and A.K. Singh2; 1Roswell Park Cancer Institute, Buffalo, NY, 2Roswell Park Cancer Institute, Buffalo, NY, United States, 3Roswell Park Cancer Insitute, Buffalo, NY, 4Roswell Park Cancer Institue, Buffalo, NY, 5Medical University of South Carolina, Charleston, SC Purpose/Objective(s): The effect of smoking and human papillomavirus (HPV) status on the survival of oropharyngeal squamous cell carcinoma
904
International Journal of Radiation Oncology Biology Physics
(OPSCC) undergoing definitive concurrent chemoradiation (CCRT) remains unclear. The purpose of this review was to examine these effects on survival outcomes among a single institute population. Materials/Methods: This retrospective review of OPSCC patients treated with CCRT between 2008 and 2015 was conducted. All tumors were examined for HPV 16/18 status (+/). Smoking status and other clinical characteristics were abstracted from the electronic medical record. Former smokers are patients who quit within a month of diagnosis or treatment. Descriptive summaries, overall survival (OS), and multivariate cox proportional hazard ratios (HR) were completed. Results: Out of 134 patients, 94 patients (71%) had HPV-positive (HPV+) tumors. Age, gender, and overall stage were not statistically different between patients with HPV+ or HPV-negative (HPV-) tumors. HPV+ patients had higher tumor grade (P<.01). Patients with HPV+ tumors had a higher percentage of never smokers than patients with HPV- tumors (10.3% vs 26.6%). Median pack-years were 18 for the HPV+ group versus 30 for the HPV- group. OS did not differ for HPV+ versus HPV- patients. Within HPV+ patients, current and former smokers had significantly worse OS than never smokers (P<.01). The same was true for HPV- patients, but the log-rank test for this group did not reach statistical significance (PZ.06). The 3-year survival rate for former smokers in each group was similar (HPV+: 0.77 (0.60, 0.88) and HPV-: 0.75 (0.52, 0.88). Hazard ratios for OS among current smokers compared to never/former smokers in each patient group were statistically significantly higher. Conclusion: Current smoking is associated with poor prognosis, independent of HPV status in OPSCC patients treated with CCRT. Former smokers have similar outcomes irrespective of HPV tumor status. The amount of tobacco a patient is exposed to before diagnosis cannot be altered, but every effort should be made to get patients to quit smoking as soon as possible before CCRT regardless of HPV status. Author Disclosure: A. Platek: None. V. Jakaprakash: None. M. Platek: None. V. Gupta: None. D. Cohan: None. W. Hicks: None. T. Winslow: None. A. Groman: None. S.S. Dibaj: None. H. Arshad: None. M.A. Kuriakose: None. G.W. Warren: None. A.K. Singh: None.
Conclusion: In this SEER cohort, OS was superior in both BOT and TF patients who received surgery with adjuvant radiation. OPSCC survival may be improved by treating more BOT and TF patients with surgery and adjuvant radiation. As modern, less invasive surgical techniques such as transoral robotic surgery gain wider acceptance, approaches that combine surgery and radiation (with or without chemotherapy) while minimizing morbidity and lack of function should be attempted. Author Disclosure: A. Platek: None. V. Jayaprakash: None. M. Platek: None. V. Gupta: None. D. Cohan: None. W. Hicks: None. T. Winslow: None. A. Groman: None. S.S. Dibaj: None. H. Arshad: None. M.A. Kuriakose: None. G.W. Warren: None. A.K. Singh: None.
182 Positive Effect of Surgery Regardless of Stage on Oropharynx Subsites Base of Tongue and Tonsillar-Fossa: A SEER Analysis A. Platek,1 V. Jayaprakash,2 M. Platek,2 V. Gupta,1 D. Cohan,1 W. Hicks,1 T. Winslow,3 A. Groman,4 S.S. Dibaj,1 H. Arshad,1 M.A. Kuriakose,1 G.W. Warren,5 and A.K. Singh2; 1Roswell Park Cancer Institute, Buffalo, NY, 2Roswell Park Cancer Institute, Buffalo, NY, United States, 3 Roswell Park Cancer Insitute, Buffalo, NY, 4Roswell Park Cancer Institue, Buffalo, NY, 5Medical University of South Carolina, Charleston, SC Purpose/Objective(s): There is increasing interest in the use of robotic surgery in carcinoma of the oropharynx. The purpose of this study was to examine survival outcomes among 2 oropharyngeal subsites (tonsillarfossa [TF] and base of tongue [BOT]). Materials/Methods: We conducted a retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results (SEER) Program. The SEER cohort included 8073 primary BOT and TF SCC patients without distant metastases treated between 2004 and 2011. Primary outcome measures were subsite-based differences in overall survival (OS) and disease-specific survival (DSS) for TF and BOT patients stratified by overall stage and comparing treatment method for each subsite. Cox proportional hazard ratios were estimated for each group. Results: For all stages combined, both BOT and TF patients who received surgery with radiation had superior OS (P<.01). The same was true when analyses were stratified by stage within each subsite. Multivariate hazard ratios adjusted for age, gender, race, and tumor grade for OS were statistically significantly higher for both BOT and TF patients who did not receive surgery compared to those who did receive surgery for each stage.
183 Organ Preservation in Patients With Orbit-Invasive Sinonasal Cancer M.B. Yusuf,1 M.J. Amsbaugh,2 C.L. Silverman,2 J. Bumpous,2 C.A. Perez,2 K. Potts,2 P. Tennant,2 R. Redman,2 M.H. Bertke,2 and N.E. Dunlap2; 1University of Louisville School of Medicine, Louisville, KY, 2University of Louisville, Louisville, KY Purpose/Objective(s): The optimal treatment strategy for patients with orbital encroachment of sinonasal cancer is not known. We sought to determine whether organ preservation with neoadjuvant therapy was possible in patients who were determined to require an exenteration for locally advanced sinonasal cancer. Materials/Methods: All patients presenting to our institutional head and neck cancer clinic from 2005 to 2014 were reviewed from a prospective database. Patient characteristics, disease, treatment, and toxicity data were collected. Kaplan-Meier methods were used to estimate survival. Log-rank test and cox proportional hazards modeling were used to examine predictive factors. Results: Twenty patients were determined by our multidisciplinary team to require an orbital exenteration as part of definitive treatment of their sinonasal cancer. Fourteen patients underwent orbital preservation (OP). Neoadjuvant treatment consisted of concurrent chemoradiation (CRT) in all patients aside from 2 who refused chemotherapy and underwent radiation therapy (RT) alone. Six patients received primary surgery followed by adjuvant CRT. Treatment groups were well balanced with respect to age, sex, site, stage, and histology. Five patients (36%) receiving neoadjuvant therapy had complete disease response at time of surgery. With a median time of follow-up of 18.8 months, actuarial exenteration-free survival was 62% at 2 years for patients undergoing OP. No patients receiving neoadjuvant therapy required an immediate posttreatment orbital exenteration; however, 1 patient required salvage orbital exenteration when she experienced local failure 35 months after treatment. At 2 years, there were no significant differences in local-regional control (75% vs 60%, PZ.997), progression-free survival (40% vs 36%, PZ.493), or overall survival (40% vs 58%, PZ.815) between patients receiving OP or upfront surgery (PZ.815). On multivariate analysis, tumor site predicted for localregional control (maxillary: 86%, nasal cavity: 80%, ethmoid sinus: 40%, PZ.050). Patients with nasal cavity tumors demonstrated a trend toward improved OS with a hazard ratio of 0.240 (95% confidence interval .053 1.08). Treatment was well tolerated in both groups. One patient treated with OP experienced grade 3 radiation-related toxicity, developing dysphagia which improved with medical management. However, 1 patient developed renal failure following his first dose of cisplatin and subsequently died before completion of treatment. Conclusion: For patients with orbital encroachment of sinonasal cancer, neoadjuvant CRT can preserve the orbit while offering similar survival and disease control compared to upfront orbital exenteration. Author Disclosure: M.B. Yusuf: None. M.J. Amsbaugh: None. C.L. Silverman: None. J. Bumpous: None. C.A. Perez: None. K. Potts: None. P. Tennant: None. R. Redman: None. M.H. Bertke: None. N.E. Dunlap: None.
Posters
tumor board checklist with review of all newly diagnosed head and neck patients prior to and after implementation. Author Disclosure: W. Swegal: None. S. Chang: None.
179 Dramatic Reduction in the Need for Feeding Tube Use in Human PappilomavirusePositive Oropharyngeal Cancer in the Intensity Modulated Radiation Therapy Era S. Koyfman,1 M.C. Ward,2 N. Houston,2 N.P. Joshi,1 B. Harr,2 T. Nwizu,2 D.J. Adelstein,2 P. Xia,1 and J.F. Greskovich, Jr3; 1Cleveland Clinic Foundation, Cleveland, OH, 2Cleveland Clinic, Cleveland, OH, 3 Cleveland Clinic Florida, Weston, FL Purpose/Objective(s): Human papillomavirus (HPV)-positive oropharyngeal cancer patients have improved cancer-related outcomes and appear to tolerate treatment with less morbidity. We hypothesize that feeding tube rates are decreasing selectively in this population. Materials/Methods: Patients treated with definitive chemoradiation (CRT; >66 Gy) for head and neck squamous cell cancer between 2007 and 2014 were included in this institutional review obardeapproved study. Patients were treated with 3-dimensional CRT in the earlier years of the study and intensity modulated radiation therapy (IMRT) since 2009. All patients were treated with concurrent chemotherapy, typically cisplatin based (90%), or with cetuximab (10%). At our institution, prophylactic feeding tubes (FTs) are typically avoided, and reactive FTs are used if patients lose excessive amounts of weight or experience dehydration requiring admission. Analysis of Variance trend test was performed to identify the significance of temporal trends in the use of FTs over time. Results: Of 421 patients included in this study, 194 (46%) had an FT placed. Of these, corpaks were used in 84%, while percutaneous endoscopic gastrostomy (PEG) tubes were used in the remainder. HPVpositive oropharyngeal cancers comprised 280 pts (66%), while the remainder included pts with cancers of the larynx (15%), HPV-negative oropharynx (11%), hypopharynx (4.5%), and nasopharynx (2.5%). Median age was 58 years, 84% were male, and 76% had a smoking history (median pack-years, 27). Median dose of RT was 72 Gy (68-78 Gy). Rates of FT use steadily declined for patients with HPV-positive oropharynx cancer, with a highly significant decrease from 80% in 2007 to 24% in 2014 (R2Z0.931; PZ.0001). This pattern was not seen for all other (HPV-negative) patients (see Table 1). Median duration of FT use was 60 days and did not differ by HPV status. Overall, only 40 pts (10%) had an FT beyond 90 days following IMRT, and only 15 patients (3.6%) had an FT at last follow-up. Conclusion: FT use has become the exception rather than the rule in patients with HPV-positive oropharyngeal cancer undergoing definitive CRT. Routine FT use should be avoided in this population. Author Disclosure: S. Koyfman: None. M.C. Ward: None. N. Houston: None. N.P. Joshi: None. B. Harr: None. T. Nwizu: None. D.J. Adelstein: None. P. Xia: None. J.F. Greskovich: None.
903
180 Proliferation Saturation Index Predicts Oropharyngeal Squamous Cell Cancer Gross Tumor Volume Reduction to Prospectively Identify Patients for Adaptive Radiation Therapy T. Lewin,1 J. Kim,2 K. Latifi,3 J. Poleszczuk,4 J. Bull,1 H. Byrne,1 J.F. Torres-Roca,3 E.G. Moros,3 R. Gatenby,2 L.B. Harrison,3 J. Heukelom,5 A.S.R. Mohamed,6 D.I. Rosenthal,6 C.D. Fuller,6 J.J. Caudell,3 and H. Enderling4; 1University of Oxford, Oxford, United Kingdom, 2H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, 3 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 4 H. Lee Moffitt Cancer Center, Tampa, FL, 5Netherlands Cancer Institute, Amsterdam, Netherlands, 6The University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): Radiation therapy (RT) for human papillomavirus (HPV)-positive oropharyngeal squamous cell cancer (OPX) provides 3year locoregional control (LRC) rates of 75% to 95%. Given the excellent cancer control outcomes for OPX following RT, there is significant interest in reducing therapy intensity, such as adaptive radiation therapy (ART), for rapidly shrinking tumor volumes to improve organ at risk sparing. However, we have limited understanding of which patients will be suitable for ART. Proliferation saturation index (PSI) is defined as a ratio of tumor volume to host tissue carrying capacity. Tissue carrying capacity (K) is an integral measure of the maximum tumor volume that can be supported by the current tumor environment including oxygen and nutrient availability, immune surveillance, and acidity. The PSI can be measured from 2 pretreatment computed tomographic (CT) scans separated in time. We hypothesized that PSI may be able to define a subgroup of patients with rapidly shrinking tumors during RT who may gain the most benefit from ART. Materials/Methods: From an MDACC institutional database, 9 patients with OPX treated with RT and concurrent chemotherapy were identified. Patient demographics, treatment, and outcomes were extracted. PSI was estimated from routine pre-RT and RT planning simulation computer tomography scans and the Gompertz tumor growth model. Gross tumor volume (GTV) was contoured on weekly CT scans obtained during treatment to estimate tumor shrinkage. GTV reductions during fractionated RT were calculated as a function of PSI. Results: Gompertz tumor growth with patient-specific PSI values fit retrospective data with high confidence (R2>0.93). Median PSI was 0.1 (range 0.01-0.3). Median GTV was 23.6 cm3 (range 3.5-62). Of the 9 patients, 3 had GTV reductions of >20% within the first 3 weeks. This was correlated with PSI values less than 0.07. Conclusion: PSI derived from standard of care CT images may be able to prospectively identify candidates for ART prior to treatment. Author Disclosure: T. Lewin: None. J. Kim: None. K. Latifi: None. J. Poleszczuk: None. J. Bull: None. H. Byrne: None. J.F. Torres-Roca: None. E.G. Moros: None. R. Gatenby: None. L.B. Harrison: None. J. Heukelom: None. A.S. Mohamed: None. D.I. Rosenthal: None. C.D. Fuller: None. J.J. Caudell: None. H. Enderling: None.
181 Abstract 179; Table 1 Year
HPV+ oropharynx feeding tube
All other feeding tube
2007 2008 2009 2010 2011 2012 2013 2014
80% 59.25% 53.33% 54% 29.26% 41.86% 25% 23.91%
34.37% 24.24% 32.43% 52.94% 61.53% 46.66% 38.46% 21.87%
The Effect of Smoking and Human Papillomavirus Status on Survival in Oropharyngeal Squamous Cell Carcinoma Patients Undergoing Concurrent Chemoradiation A. Platek,1 V. Jakaprakash,1 M. Platek,2 V. Gupta,1 D. Cohan,1 W. Hicks,1 T. Winslow,3 A. Groman,4 S.S. Dibaj,1 H. Arshad,1 M.A. Kuriakose,1 G.W. Warren,5 and A.K. Singh2; 1Roswell Park Cancer Institute, Buffalo, NY, 2Roswell Park Cancer Institute, Buffalo, NY, United States, 3Roswell Park Cancer Insitute, Buffalo, NY, 4Roswell Park Cancer Institue, Buffalo, NY, 5Medical University of South Carolina, Charleston, SC Purpose/Objective(s): The effect of smoking and human papillomavirus (HPV) status on the survival of oropharyngeal squamous cell carcinoma
904
International Journal of Radiation Oncology Biology Physics
(OPSCC) undergoing definitive concurrent chemoradiation (CCRT) remains unclear. The purpose of this review was to examine these effects on survival outcomes among a single institute population. Materials/Methods: This retrospective review of OPSCC patients treated with CCRT between 2008 and 2015 was conducted. All tumors were examined for HPV 16/18 status (+/). Smoking status and other clinical characteristics were abstracted from the electronic medical record. Former smokers are patients who quit within a month of diagnosis or treatment. Descriptive summaries, overall survival (OS), and multivariate cox proportional hazard ratios (HR) were completed. Results: Out of 134 patients, 94 patients (71%) had HPV-positive (HPV+) tumors. Age, gender, and overall stage were not statistically different between patients with HPV+ or HPV-negative (HPV-) tumors. HPV+ patients had higher tumor grade (P<.01). Patients with HPV+ tumors had a higher percentage of never smokers than patients with HPV- tumors (10.3% vs 26.6%). Median pack-years were 18 for the HPV+ group versus 30 for the HPV- group. OS did not differ for HPV+ versus HPV- patients. Within HPV+ patients, current and former smokers had significantly worse OS than never smokers (P<.01). The same was true for HPV- patients, but the log-rank test for this group did not reach statistical significance (PZ.06). The 3-year survival rate for former smokers in each group was similar (HPV+: 0.77 (0.60, 0.88) and HPV-: 0.75 (0.52, 0.88). Hazard ratios for OS among current smokers compared to never/former smokers in each patient group were statistically significantly higher. Conclusion: Current smoking is associated with poor prognosis, independent of HPV status in OPSCC patients treated with CCRT. Former smokers have similar outcomes irrespective of HPV tumor status. The amount of tobacco a patient is exposed to before diagnosis cannot be altered, but every effort should be made to get patients to quit smoking as soon as possible before CCRT regardless of HPV status. Author Disclosure: A. Platek: None. V. Jakaprakash: None. M. Platek: None. V. Gupta: None. D. Cohan: None. W. Hicks: None. T. Winslow: None. A. Groman: None. S.S. Dibaj: None. H. Arshad: None. M.A. Kuriakose: None. G.W. Warren: None. A.K. Singh: None.
Conclusion: In this SEER cohort, OS was superior in both BOT and TF patients who received surgery with adjuvant radiation. OPSCC survival may be improved by treating more BOT and TF patients with surgery and adjuvant radiation. As modern, less invasive surgical techniques such as transoral robotic surgery gain wider acceptance, approaches that combine surgery and radiation (with or without chemotherapy) while minimizing morbidity and lack of function should be attempted. Author Disclosure: A. Platek: None. V. Jayaprakash: None. M. Platek: None. V. Gupta: None. D. Cohan: None. W. Hicks: None. T. Winslow: None. A. Groman: None. S.S. Dibaj: None. H. Arshad: None. M.A. Kuriakose: None. G.W. Warren: None. A.K. Singh: None.
182 Positive Effect of Surgery Regardless of Stage on Oropharynx Subsites Base of Tongue and Tonsillar-Fossa: A SEER Analysis A. Platek,1 V. Jayaprakash,2 M. Platek,2 V. Gupta,1 D. Cohan,1 W. Hicks,1 T. Winslow,3 A. Groman,4 S.S. Dibaj,1 H. Arshad,1 M.A. Kuriakose,1 G.W. Warren,5 and A.K. Singh2; 1Roswell Park Cancer Institute, Buffalo, NY, 2Roswell Park Cancer Institute, Buffalo, NY, United States, 3 Roswell Park Cancer Insitute, Buffalo, NY, 4Roswell Park Cancer Institue, Buffalo, NY, 5Medical University of South Carolina, Charleston, SC Purpose/Objective(s): There is increasing interest in the use of robotic surgery in carcinoma of the oropharynx. The purpose of this study was to examine survival outcomes among 2 oropharyngeal subsites (tonsillarfossa [TF] and base of tongue [BOT]). Materials/Methods: We conducted a retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results (SEER) Program. The SEER cohort included 8073 primary BOT and TF SCC patients without distant metastases treated between 2004 and 2011. Primary outcome measures were subsite-based differences in overall survival (OS) and disease-specific survival (DSS) for TF and BOT patients stratified by overall stage and comparing treatment method for each subsite. Cox proportional hazard ratios were estimated for each group. Results: For all stages combined, both BOT and TF patients who received surgery with radiation had superior OS (P<.01). The same was true when analyses were stratified by stage within each subsite. Multivariate hazard ratios adjusted for age, gender, race, and tumor grade for OS were statistically significantly higher for both BOT and TF patients who did not receive surgery compared to those who did receive surgery for each stage.
183 Organ Preservation in Patients With Orbit-Invasive Sinonasal Cancer M.B. Yusuf,1 M.J. Amsbaugh,2 C.L. Silverman,2 J. Bumpous,2 C.A. Perez,2 K. Potts,2 P. Tennant,2 R. Redman,2 M.H. Bertke,2 and N.E. Dunlap2; 1University of Louisville School of Medicine, Louisville, KY, 2University of Louisville, Louisville, KY Purpose/Objective(s): The optimal treatment strategy for patients with orbital encroachment of sinonasal cancer is not known. We sought to determine whether organ preservation with neoadjuvant therapy was possible in patients who were determined to require an exenteration for locally advanced sinonasal cancer. Materials/Methods: All patients presenting to our institutional head and neck cancer clinic from 2005 to 2014 were reviewed from a prospective database. Patient characteristics, disease, treatment, and toxicity data were collected. Kaplan-Meier methods were used to estimate survival. Log-rank test and cox proportional hazards modeling were used to examine predictive factors. Results: Twenty patients were determined by our multidisciplinary team to require an orbital exenteration as part of definitive treatment of their sinonasal cancer. Fourteen patients underwent orbital preservation (OP). Neoadjuvant treatment consisted of concurrent chemoradiation (CRT) in all patients aside from 2 who refused chemotherapy and underwent radiation therapy (RT) alone. Six patients received primary surgery followed by adjuvant CRT. Treatment groups were well balanced with respect to age, sex, site, stage, and histology. Five patients (36%) receiving neoadjuvant therapy had complete disease response at time of surgery. With a median time of follow-up of 18.8 months, actuarial exenteration-free survival was 62% at 2 years for patients undergoing OP. No patients receiving neoadjuvant therapy required an immediate posttreatment orbital exenteration; however, 1 patient required salvage orbital exenteration when she experienced local failure 35 months after treatment. At 2 years, there were no significant differences in local-regional control (75% vs 60%, PZ.997), progression-free survival (40% vs 36%, PZ.493), or overall survival (40% vs 58%, PZ.815) between patients receiving OP or upfront surgery (PZ.815). On multivariate analysis, tumor site predicted for localregional control (maxillary: 86%, nasal cavity: 80%, ethmoid sinus: 40%, PZ.050). Patients with nasal cavity tumors demonstrated a trend toward improved OS with a hazard ratio of 0.240 (95% confidence interval .053 1.08). Treatment was well tolerated in both groups. One patient treated with OP experienced grade 3 radiation-related toxicity, developing dysphagia which improved with medical management. However, 1 patient developed renal failure following his first dose of cisplatin and subsequently died before completion of treatment. Conclusion: For patients with orbital encroachment of sinonasal cancer, neoadjuvant CRT can preserve the orbit while offering similar survival and disease control compared to upfront orbital exenteration. Author Disclosure: M.B. Yusuf: None. M.J. Amsbaugh: None. C.L. Silverman: None. J. Bumpous: None. C.A. Perez: None. K. Potts: None. P. Tennant: None. R. Redman: None. M.H. Bertke: None. N.E. Dunlap: None.