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The Role of Radiation Therapy for Cancers of the External Auditory Canal and Middle Ear
Poster Viewing Session E317
Volume 93 Number 3S Supplement 2015 respectively. In these patients, 5-year DFS and OS did not differ significantly according to use of chemotherapy during PORT (P>.05). Conclusion: Expression of p16 is a strong, independent prognostic factor of survival in the postoperative setting of OPSCC. The favorable prognosis of p16+ OPSCC with high-risk factors has led to a re-examination of traditional risk stratification. A prospective validation of deintensification approaches should be considered depending on the risk group in p16+ tumors. Author Disclosure: J. Lee: None. J. Chang: None. H. Kwon: None. S. Kim: None. Y. Kim: None. K. Keum: None.
2786 Clinical Profile and Treatment Outcome of Squamous Cell Carcinoma (SCC) Hypopharynx: A Single-Institution Experience R. Resmi,1 R.R. Kumar,1 C.T. Kainickal,1 M. Rafi,2 B.M. Azariah,3 and R. Kunnambath1; 1Regional Cancer Centre, Trivandrum, India, 2 Regional Cancer Centre Trivandrum, Trivandrum, India, 3REGIONAL CANCER CENTRE, TRIVANDRUM, India Purpose/Objective(s): Hypopharyngeal cancers constitute about 7% of all head and neck malignancies. Early-stage disease is treated either by radiation therapy (RT) or surgery. Advanced stage (stages III and IVA) disease is managed by combined modality treatment. Most patients present late, are nutritionally compromised, and, due to poor general condition, a substantial number will undergo palliative treatment unlike in other head and neck cancers. The purpose of this study was to analyze the clinical profile and treatment outcomes of hypopharyngeal squamous cell carcinoma (HSCC) patients treated during the time period of 2008 to 2011. Materials/Methods: The records of 300 patients were analyzed. The median follow-up was 47 months. Radical RT dose was 60 to 66 Gy. Induction chemotherapy was platinum-based combination, and concurrent agent was cisplatin. Disease-free survival (DFS) and overall survival (OS) were generated using log-rank test and Kaplan Meier curves respectively. Results: The majority of patients were males (247; 82.3%). The most common subsite was pyriform sinus (218; 72.7%), followed by postcricoid (65; 21.6%) and posterior pharyngeal wall (17; 5.6%). Fifteen (5 %) patients had stage II disease, 63 (21%) had stage III, 127 (42.3%) had stage IVA, 90 (30%) had IVB, and 5 (1.7%) presented with stage IVC disease. Two hundred thirty-four (78%) patients were planned for radical intent treatment and 66 (22%) treated with palliative intent. Two hundred and nine patients (69.6%) completed the planned radical treatment without interruptions. Among them, 61 patients (29.2%) were treated with concurrent chemoradiation, 52 patients (24.9%) underwent RT alone, 51 patients (24.4%) underwent induction chemotherapy followed by chemoradiation, and 33 patients (15.7%) underwent induction chemotherapy followed by RT alone. Thirteen patients (5.7 %) underwent primary surgery, and all of them received adjuvant RT. Seventeen patients had treatment interruptions. Out of 170 patients who had complete response after radical treatment, 53 patients (31.1%) developed recurrence, the most common site being the primary site. Median time to recurrence was 11.63 months. Fourteen patients (15.2%) underwent salvage surgery for residual/ recurrence. Ten patients (3.3%) developed second malignancies. At 5 years, disease-free survival was 33.8% and overall survival was 34.4%. Conclusion: In our series, the most common subsite at presentation was pyriform sinus. Most patients presented with advanced stage IV disease. Five-year DFS and OS closely follow each other, reflecting the poor salvage rates. Author Disclosure: R. Resmi: None. R.R. Kumar: None. C.T. Kainickal: None. M. Rafi: None. B.M. Azariah: None. R. Kunnambath: None.
2787 The Role of Radiation Therapy for Cancers of the External Auditory Canal and Middle Ear J. Choi, J. Lee, and K.C. Keum; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
Purpose/Objective(s): The objective of this study was to evaluate the clinical outcomes of patients with carcinoma of the external auditory canal (EAC) and middle ear treated with radiation therapy (RT). Materials/Methods: Thirty-two patients who received RT from 1990 through 2013 were retrospectively analyzed. Twenty-one patients (65.6%) were treated with postoperative RT and the remaining 11 patients (34.4%) with definitive RT. Early stage based on Pittsburgh classification was defined as T1/T2 (nZ12) and advanced stage as T3/T4 or N positive (nZ20). The median radiation dose for postoperative RT and definitive RT was 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered in 7 patients (21.9%). Results: The median follow-up period after RT was 51 (range, 7-286) months. The 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for patients with early stage versus advanced stage was 55.6% (nZ5/9) and 50% (nZ6/12) in postoperative RT group and 66.7% (nZ2/3) and 37.5% (nZ3/8) in definitive RT group, respectively. Overall, 14 patients (46.7%) with 15 cases experienced treatment failures, which were classified as local in 4 cases, regional in 1 case, and distant in 10 cases. Conclusion: Patients with early stage achieved better outcome with definitive RT, whereas advanced stage with postoperative RT. However, distant failure after RT with or without surgery is the main issue, suggesting that the most beneficial therapeutic approach remains to be determined. Author Disclosure: J. Choi: None. J. Lee: None. K. Keum: None.
2788 Anatomical and Dosimetric Changes in Organs at Risk and Target Volumes During Intensity Modulated Radiation Therapy for Oropharyngeal Cancers M. Rafi,1 A. Baby,2 R.R. Kumar,3 C.T. Kainickal,3 S. Bhasi,4 P.S. George,4 B.M. Azariah,5 and R. Kunnambath3; 1Regional Cancer Centre Trivandrum, Trivandrum, India, 2Regional Cancer Centre, TRIVANDRUM, India, 3Regional Cancer Centre, Trivandrum, India, 4Regional Cancer Centre, Thiruvananthapuram, India, 5REGIONAL CANCER CENTRE, TRIVANDRUM, India Purpose/Objective(s): Rapid tumor shrinkage, weight loss, and shrinkage of parotid glands are well described in head and neck squamous cell carcinomas during the 6- to 7-week course of radiation therapy (RT). This study was planned to quantify the anatomical and dosimetric changes with respect to the tumor volumes and critical organs during the course of intensity modulated RT (IMRT). Materials/Methods: A total of 10 patients with primary oropharyngeal cancer treated using IMRT technique in a tertiary cancer center in South India were included in the study. Gross tumor volume (GTV) and corresponding clinical target volumes (CTV66, CTV60 and CTV54) were contoured on the initial computed tomography (CT) (scan1) along with the organs at risk (OAR). A planning target volume (PTV) margin of 5 mm was used and arc IMRT plans were generated (Plan1). A repeat CT simulation was done after 15 fractions (scan 2) and a recontouring of the target volumes and OARs were done. A CT-CT fusion based on bony landmarks was done between scan 1 and 2. The beam configurations of the initial IMRT plan including the intensity profile of each beam was reproduced into scan 2 and dose calculation was then done without reoptimization (plan2). The mean body weight was recorded prior to the start of RT and at the end of 15 fractions. GTVs (cc), the volume of parotid glands, and the volume of spinal cord and larynx were noted in scan 1 and 2. The mean dose to GTV, CTV66 and PTV 66; V100 (portion of target volume which receives 100% of prescribed dose) of GTV and CTV 66; V95 (volume of PTV receiving at least 95% of prescribed dose) and D 95 (dose received by 95% volume of the PTV) for PTV were noted for each plan. The mean dose to the parotid, larynx, and spinal cord; V20 (volume of parotid gland receiving at least 20 Gy) and V30 (volume of parotid gland receiving at least 30 Gy) were recorded for both plans.
Volume 93 Number 3S Supplement 2015 respectively. In these patients, 5-year DFS and OS did not differ significantly according to use of chemotherapy during PORT (P>.05). Conclusion: Expression of p16 is a strong, independent prognostic factor of survival in the postoperative setting of OPSCC. The favorable prognosis of p16+ OPSCC with high-risk factors has led to a re-examination of traditional risk stratification. A prospective validation of deintensification approaches should be considered depending on the risk group in p16+ tumors. Author Disclosure: J. Lee: None. J. Chang: None. H. Kwon: None. S. Kim: None. Y. Kim: None. K. Keum: None.
2786 Clinical Profile and Treatment Outcome of Squamous Cell Carcinoma (SCC) Hypopharynx: A Single-Institution Experience R. Resmi,1 R.R. Kumar,1 C.T. Kainickal,1 M. Rafi,2 B.M. Azariah,3 and R. Kunnambath1; 1Regional Cancer Centre, Trivandrum, India, 2 Regional Cancer Centre Trivandrum, Trivandrum, India, 3REGIONAL CANCER CENTRE, TRIVANDRUM, India Purpose/Objective(s): Hypopharyngeal cancers constitute about 7% of all head and neck malignancies. Early-stage disease is treated either by radiation therapy (RT) or surgery. Advanced stage (stages III and IVA) disease is managed by combined modality treatment. Most patients present late, are nutritionally compromised, and, due to poor general condition, a substantial number will undergo palliative treatment unlike in other head and neck cancers. The purpose of this study was to analyze the clinical profile and treatment outcomes of hypopharyngeal squamous cell carcinoma (HSCC) patients treated during the time period of 2008 to 2011. Materials/Methods: The records of 300 patients were analyzed. The median follow-up was 47 months. Radical RT dose was 60 to 66 Gy. Induction chemotherapy was platinum-based combination, and concurrent agent was cisplatin. Disease-free survival (DFS) and overall survival (OS) were generated using log-rank test and Kaplan Meier curves respectively. Results: The majority of patients were males (247; 82.3%). The most common subsite was pyriform sinus (218; 72.7%), followed by postcricoid (65; 21.6%) and posterior pharyngeal wall (17; 5.6%). Fifteen (5 %) patients had stage II disease, 63 (21%) had stage III, 127 (42.3%) had stage IVA, 90 (30%) had IVB, and 5 (1.7%) presented with stage IVC disease. Two hundred thirty-four (78%) patients were planned for radical intent treatment and 66 (22%) treated with palliative intent. Two hundred and nine patients (69.6%) completed the planned radical treatment without interruptions. Among them, 61 patients (29.2%) were treated with concurrent chemoradiation, 52 patients (24.9%) underwent RT alone, 51 patients (24.4%) underwent induction chemotherapy followed by chemoradiation, and 33 patients (15.7%) underwent induction chemotherapy followed by RT alone. Thirteen patients (5.7 %) underwent primary surgery, and all of them received adjuvant RT. Seventeen patients had treatment interruptions. Out of 170 patients who had complete response after radical treatment, 53 patients (31.1%) developed recurrence, the most common site being the primary site. Median time to recurrence was 11.63 months. Fourteen patients (15.2%) underwent salvage surgery for residual/ recurrence. Ten patients (3.3%) developed second malignancies. At 5 years, disease-free survival was 33.8% and overall survival was 34.4%. Conclusion: In our series, the most common subsite at presentation was pyriform sinus. Most patients presented with advanced stage IV disease. Five-year DFS and OS closely follow each other, reflecting the poor salvage rates. Author Disclosure: R. Resmi: None. R.R. Kumar: None. C.T. Kainickal: None. M. Rafi: None. B.M. Azariah: None. R. Kunnambath: None.
2787 The Role of Radiation Therapy for Cancers of the External Auditory Canal and Middle Ear J. Choi, J. Lee, and K.C. Keum; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
Purpose/Objective(s): The objective of this study was to evaluate the clinical outcomes of patients with carcinoma of the external auditory canal (EAC) and middle ear treated with radiation therapy (RT). Materials/Methods: Thirty-two patients who received RT from 1990 through 2013 were retrospectively analyzed. Twenty-one patients (65.6%) were treated with postoperative RT and the remaining 11 patients (34.4%) with definitive RT. Early stage based on Pittsburgh classification was defined as T1/T2 (nZ12) and advanced stage as T3/T4 or N positive (nZ20). The median radiation dose for postoperative RT and definitive RT was 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered in 7 patients (21.9%). Results: The median follow-up period after RT was 51 (range, 7-286) months. The 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for patients with early stage versus advanced stage was 55.6% (nZ5/9) and 50% (nZ6/12) in postoperative RT group and 66.7% (nZ2/3) and 37.5% (nZ3/8) in definitive RT group, respectively. Overall, 14 patients (46.7%) with 15 cases experienced treatment failures, which were classified as local in 4 cases, regional in 1 case, and distant in 10 cases. Conclusion: Patients with early stage achieved better outcome with definitive RT, whereas advanced stage with postoperative RT. However, distant failure after RT with or without surgery is the main issue, suggesting that the most beneficial therapeutic approach remains to be determined. Author Disclosure: J. Choi: None. J. Lee: None. K. Keum: None.
2788 Anatomical and Dosimetric Changes in Organs at Risk and Target Volumes During Intensity Modulated Radiation Therapy for Oropharyngeal Cancers M. Rafi,1 A. Baby,2 R.R. Kumar,3 C.T. Kainickal,3 S. Bhasi,4 P.S. George,4 B.M. Azariah,5 and R. Kunnambath3; 1Regional Cancer Centre Trivandrum, Trivandrum, India, 2Regional Cancer Centre, TRIVANDRUM, India, 3Regional Cancer Centre, Trivandrum, India, 4Regional Cancer Centre, Thiruvananthapuram, India, 5REGIONAL CANCER CENTRE, TRIVANDRUM, India Purpose/Objective(s): Rapid tumor shrinkage, weight loss, and shrinkage of parotid glands are well described in head and neck squamous cell carcinomas during the 6- to 7-week course of radiation therapy (RT). This study was planned to quantify the anatomical and dosimetric changes with respect to the tumor volumes and critical organs during the course of intensity modulated RT (IMRT). Materials/Methods: A total of 10 patients with primary oropharyngeal cancer treated using IMRT technique in a tertiary cancer center in South India were included in the study. Gross tumor volume (GTV) and corresponding clinical target volumes (CTV66, CTV60 and CTV54) were contoured on the initial computed tomography (CT) (scan1) along with the organs at risk (OAR). A planning target volume (PTV) margin of 5 mm was used and arc IMRT plans were generated (Plan1). A repeat CT simulation was done after 15 fractions (scan 2) and a recontouring of the target volumes and OARs were done. A CT-CT fusion based on bony landmarks was done between scan 1 and 2. The beam configurations of the initial IMRT plan including the intensity profile of each beam was reproduced into scan 2 and dose calculation was then done without reoptimization (plan2). The mean body weight was recorded prior to the start of RT and at the end of 15 fractions. GTVs (cc), the volume of parotid glands, and the volume of spinal cord and larynx were noted in scan 1 and 2. The mean dose to GTV, CTV66 and PTV 66; V100 (portion of target volume which receives 100% of prescribed dose) of GTV and CTV 66; V95 (volume of PTV receiving at least 95% of prescribed dose) and D 95 (dose received by 95% volume of the PTV) for PTV were noted for each plan. The mean dose to the parotid, larynx, and spinal cord; V20 (volume of parotid gland receiving at least 20 Gy) and V30 (volume of parotid gland receiving at least 30 Gy) were recorded for both plans.