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Treatment Outcomes of Radiation Therapy Combined with Superselective Intra-arterial Infusion Therapy for Maxillary Sinus Cancer
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Volume 99 Number 2S Supplement 2017 and 0.013 for Levene test, Student’s t-test and Welch modified t-text/ Wilcox, respectively]. However, no statistically significant changes were noted within the IMXT group, which demonstrated a mean baseline NLR of 3.37 and a mean 4th-week NLR of 3.91. Conclusion: Compared with the pretreatment baseline, NLR decreased significantly by the 4th week of IMCT. However, no significant difference was observed in IMXT group. The clinical implication of such a difference is not known, requires further investigation, may have an immunologic basis, and may be an indication of the different physical and radiobiologic properties of carbon-ion versus X-ray based radiotherapy. Author Disclosure: L. Kong: None. S. Wang: None. C. Hu: None. J. Hu: None. J.J. Lu: None.
2828 Treatment Outcomes of Radiation Therapy Combined with Superselective Intra-arterial Infusion Therapy for Maxillary Sinus Cancer K. Konishi,1 M. Kamiya,2 T. Komatsu,1 S. Yamashita,2 Y. Itou,2 T. Kosugi,3 K. Suzuki,4 H. Sakahara,2 and K. Nakamura1; 1Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Japan, 2Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Japan, 3 Fujieda Municipal General Hospital, Surugadai 4-1-11, Fujieda, Japan, 4 Fujinomiya City General Hospital, Nishiki-cho 3-1, Fujinomiya, Japan Purpose/Objective(s): The purpose of this retrospective study is to evaluate the efficacy of radiotherapy combined with superselective intraarterial infusion therapy of cisplatin for locally advanced maxillary sinus cancer at single institution. Materials/Methods: We have evaluated 38 patients with locally advanced maxillary sinus cancer, who were treated with curative intent radiotherapy combined with superselective intra-arterial infusion therapy of cisplatin from 2002 to 2016. There were 31 males and 7 females. The median age was 67.5 years (range 47 to 87 years). Stage distribution was T2 in 1 case, T3 in 5 cases, T4a in 23 cases, and T4b in 9 cases. All patients have no nodal involvement. There were 36 patients who had squamous cell carcinomas, and 2 with undifferentiated carcinomas. Thirty-five patients received three-dimensional conventional radiotherapy, and the 3 most recent patients received intensitymodulated radiation therapy. We used 4 MV and/or 10 MV X-ray with or without electron beams. Median prescribed dose was 66 Gy (range 50 to 70 Gy) in 2 Gy/fraction. All patients did not receive either prophylactic neck irradiation or volume reduction surgery before radiotherapy. Superselective intra-arterial infusions of high-dose cisplatin was performed in 36 patients with simultaneous intra-venous infusions of thiosulfate to neutralize cisplatin toxicity, and 2 patients received selective intra-arterial infusion chemotherapy without sodium thiosulfate neutralization. All patients were treated with median 6 cycles (range 2 to 10 cycles) of intra-arterial infusion chemotherapy per week during radiotherapy. Systemic chemotherapy was also combined in 2 patients after the completion of radiotherapy. Results: The median follow-up period was 38.9 months (range 3.6 to 178.3 months). The 5-year overall survival rate, disease-free survival rate, and local progression-free survival rate were 78.3% (T2-3/T4:100%/70.4%), 44.5% (T23/T4:83.3%/36.0%) and 58.3% (T2-3/T4:83.3%/53.7%), respectively. Although 13 patients had persistence of disease, delayed local failure occurred only in 2, regional recurrence in 3, and distant metastasis in 4. As salvage treatment, 9 patients underwent salvage surgery, and 2 patients underwent stereotactic radiotherapy. Although acute Grade 3 mucositis developed in 10 patients, no renal dysfunction occurred during the treatment. There were 9 late complications, including osteonecrosis (2 patients), carotid cavernous sinus fistula (1 patient), cateract (2 patients), blindness (4 patients) as late adverse reactions. Conclusion: Radiotherapy combined with superselective intra-arterial infusion therapy of cisplatin for maxillary sinus cancer appears to be efficient. However, further work is needed to decrease late complications. Author Disclosure: K. Konishi: None. M. Kamiya: None. T. Komatsu: None. S. Yamashita: None. Y. Itou: None. T. Kosugi: None. K. Suzuki: None. H. Sakahara: None. K. Nakamura: None.
2829 Refining Risk Stratification in HPV-Related Oropharynx Cancer: Implications for Clinical Trials S. Koyfman,1 R.B. Ross,2 N.P. Joshi,1 N. Houston,1 C.A. Reddy,1 J.F. Greskovich Jr,3 N.M. Woody,1 J.L. Geiger,4 E. Lamarre,5 B. Prendes,5 R.R. Lorenz,5 J. Scharpf,5 B.B. Burkey,5 D.J. Adelstein,4 and M.C. Ward1; 1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 2Case Western Reserve University School of Medicine, Cleveland, OH, 3Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Florida, Weston, FL, 4 Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 5Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Among patients with human papillomavirus related cancer of the oropharynx (HPV+ OPC), a highly favorable pt subgroup (T1-2N1-2b or T3N0-2b AND <10 pk yrs), and a less favorable pt subgroup (T4 OR N2c/3 OR >10 pk yrs) have been previously identified and form the basis of inclusion criteria for deintensification and intensification clinical trials, respectively. These binary definitions may ignore important outcome differences for patients with more advanced favorable or less advanced unfavorable disease. We investigated these pts to further understand their recurrence risks and appropriateness for enrollment on upcoming prospective trials. Materials/Methods: Pts with T1-2N1-2c or T3N0-2c with HPV+ OPC treated with radiation + concurrent systemic therapy from 2001-2015 were identified from an IRB approved database. Smoking status was coded on each pt as never, former (quit > 3 months before diagnosis), or active smoking (quit within 3 months of diagnosis or continued smoking during and/or after treatment). Pack-years (pk-yrs) were also captured for smokers. Freedom from recurrence (FFR) was the primary endpoint and events included local, regional and/or distant recurrence, but not death. Kaplan-Meier analysis was used to calculate actuarial FFR rates. The log-rank test was used to compare FFR rates between groups. Results: Of 334 pts included in this study, the median age was 58, median KPS was 90 and median follow-up for the entire cohort was 34 (range: 1163) months. All patients were treated with radiotherapy either in the definitive (78%) or postoperative (22%) setting. Concurrent cisplatin or cetuximab was used in 89% of patients. In pts with anatomically limited disease (T1-2N1-N2b or T3N0-2b), no significant differences in 3-yr FFR were observed in patients with <10 pk-yrs, between 10-20 pk-yrs or >20 pk-yrs (88% vs. 91% vs 89%; pZ0.80). However, active smokers had significantly inferior 3yr FRR rates compared to never/former smokers (74% vs. 91%; pZ0.0006). For patients with limited T-stage and bilateral nodal disease (T1-2N2c), 3-yr FFR rates were excellent in pts with <10pkyrs compared to those with >10pk-yr (100% vs. 82%; pZ0.07). In a subset of pts with the most anatomically advanced disease within the otherwise favorable subgroup (T3N2b), a lower than expected 3-yr FFR was observed (70% vs. 92% in T1-2N1-2b/T3N0-2a pts; pZ0.008), which was independent of pk-yrs (pZ0.68). Conclusion: Pts with anatomically favorable (T1-2N1-2b or T3N0-2a) HPV+ OPC, who are not active smokers have low rates of recurrence independent of pk-yrs. Similarly, patients with limited T-stage and bilateral nodal disease (T1-2N2c), but with <10 pk-yrs of smoking have low recurrence rates with standard of care therapy. Neither of these pt groups are likely to benefit from treatment intensification trials. Conversely, pts with T3N2b disease have higher than expected failure rates independent of smoking exposure and are poor candidates for deintensification studies. Author Disclosure: S. Koyfman: None. R.B. Ross: None. N.P. Joshi: None. N. Houston: None. C.A. Reddy: None. J.F. Greskovich: None. N.M. Woody: None. J.L. Geiger: None. E. Lamarre: None. B. Prendes: None. R.R. Lorenz: None. J. Scharpf: None. B.B. Burkey: None. D.J. Adelstein: None. M.C. Ward: None.
Volume 99 Number 2S Supplement 2017 and 0.013 for Levene test, Student’s t-test and Welch modified t-text/ Wilcox, respectively]. However, no statistically significant changes were noted within the IMXT group, which demonstrated a mean baseline NLR of 3.37 and a mean 4th-week NLR of 3.91. Conclusion: Compared with the pretreatment baseline, NLR decreased significantly by the 4th week of IMCT. However, no significant difference was observed in IMXT group. The clinical implication of such a difference is not known, requires further investigation, may have an immunologic basis, and may be an indication of the different physical and radiobiologic properties of carbon-ion versus X-ray based radiotherapy. Author Disclosure: L. Kong: None. S. Wang: None. C. Hu: None. J. Hu: None. J.J. Lu: None.
2828 Treatment Outcomes of Radiation Therapy Combined with Superselective Intra-arterial Infusion Therapy for Maxillary Sinus Cancer K. Konishi,1 M. Kamiya,2 T. Komatsu,1 S. Yamashita,2 Y. Itou,2 T. Kosugi,3 K. Suzuki,4 H. Sakahara,2 and K. Nakamura1; 1Department of Radiation Oncology, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Japan, 2Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Handayama 1-20-1, Higashi-ku, Hamamatsu, Japan, 3 Fujieda Municipal General Hospital, Surugadai 4-1-11, Fujieda, Japan, 4 Fujinomiya City General Hospital, Nishiki-cho 3-1, Fujinomiya, Japan Purpose/Objective(s): The purpose of this retrospective study is to evaluate the efficacy of radiotherapy combined with superselective intraarterial infusion therapy of cisplatin for locally advanced maxillary sinus cancer at single institution. Materials/Methods: We have evaluated 38 patients with locally advanced maxillary sinus cancer, who were treated with curative intent radiotherapy combined with superselective intra-arterial infusion therapy of cisplatin from 2002 to 2016. There were 31 males and 7 females. The median age was 67.5 years (range 47 to 87 years). Stage distribution was T2 in 1 case, T3 in 5 cases, T4a in 23 cases, and T4b in 9 cases. All patients have no nodal involvement. There were 36 patients who had squamous cell carcinomas, and 2 with undifferentiated carcinomas. Thirty-five patients received three-dimensional conventional radiotherapy, and the 3 most recent patients received intensitymodulated radiation therapy. We used 4 MV and/or 10 MV X-ray with or without electron beams. Median prescribed dose was 66 Gy (range 50 to 70 Gy) in 2 Gy/fraction. All patients did not receive either prophylactic neck irradiation or volume reduction surgery before radiotherapy. Superselective intra-arterial infusions of high-dose cisplatin was performed in 36 patients with simultaneous intra-venous infusions of thiosulfate to neutralize cisplatin toxicity, and 2 patients received selective intra-arterial infusion chemotherapy without sodium thiosulfate neutralization. All patients were treated with median 6 cycles (range 2 to 10 cycles) of intra-arterial infusion chemotherapy per week during radiotherapy. Systemic chemotherapy was also combined in 2 patients after the completion of radiotherapy. Results: The median follow-up period was 38.9 months (range 3.6 to 178.3 months). The 5-year overall survival rate, disease-free survival rate, and local progression-free survival rate were 78.3% (T2-3/T4:100%/70.4%), 44.5% (T23/T4:83.3%/36.0%) and 58.3% (T2-3/T4:83.3%/53.7%), respectively. Although 13 patients had persistence of disease, delayed local failure occurred only in 2, regional recurrence in 3, and distant metastasis in 4. As salvage treatment, 9 patients underwent salvage surgery, and 2 patients underwent stereotactic radiotherapy. Although acute Grade 3 mucositis developed in 10 patients, no renal dysfunction occurred during the treatment. There were 9 late complications, including osteonecrosis (2 patients), carotid cavernous sinus fistula (1 patient), cateract (2 patients), blindness (4 patients) as late adverse reactions. Conclusion: Radiotherapy combined with superselective intra-arterial infusion therapy of cisplatin for maxillary sinus cancer appears to be efficient. However, further work is needed to decrease late complications. Author Disclosure: K. Konishi: None. M. Kamiya: None. T. Komatsu: None. S. Yamashita: None. Y. Itou: None. T. Kosugi: None. K. Suzuki: None. H. Sakahara: None. K. Nakamura: None.
2829 Refining Risk Stratification in HPV-Related Oropharynx Cancer: Implications for Clinical Trials S. Koyfman,1 R.B. Ross,2 N.P. Joshi,1 N. Houston,1 C.A. Reddy,1 J.F. Greskovich Jr,3 N.M. Woody,1 J.L. Geiger,4 E. Lamarre,5 B. Prendes,5 R.R. Lorenz,5 J. Scharpf,5 B.B. Burkey,5 D.J. Adelstein,4 and M.C. Ward1; 1Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 2Case Western Reserve University School of Medicine, Cleveland, OH, 3Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Florida, Weston, FL, 4 Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 5Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Among patients with human papillomavirus related cancer of the oropharynx (HPV+ OPC), a highly favorable pt subgroup (T1-2N1-2b or T3N0-2b AND <10 pk yrs), and a less favorable pt subgroup (T4 OR N2c/3 OR >10 pk yrs) have been previously identified and form the basis of inclusion criteria for deintensification and intensification clinical trials, respectively. These binary definitions may ignore important outcome differences for patients with more advanced favorable or less advanced unfavorable disease. We investigated these pts to further understand their recurrence risks and appropriateness for enrollment on upcoming prospective trials. Materials/Methods: Pts with T1-2N1-2c or T3N0-2c with HPV+ OPC treated with radiation + concurrent systemic therapy from 2001-2015 were identified from an IRB approved database. Smoking status was coded on each pt as never, former (quit > 3 months before diagnosis), or active smoking (quit within 3 months of diagnosis or continued smoking during and/or after treatment). Pack-years (pk-yrs) were also captured for smokers. Freedom from recurrence (FFR) was the primary endpoint and events included local, regional and/or distant recurrence, but not death. Kaplan-Meier analysis was used to calculate actuarial FFR rates. The log-rank test was used to compare FFR rates between groups. Results: Of 334 pts included in this study, the median age was 58, median KPS was 90 and median follow-up for the entire cohort was 34 (range: 1163) months. All patients were treated with radiotherapy either in the definitive (78%) or postoperative (22%) setting. Concurrent cisplatin or cetuximab was used in 89% of patients. In pts with anatomically limited disease (T1-2N1-N2b or T3N0-2b), no significant differences in 3-yr FFR were observed in patients with <10 pk-yrs, between 10-20 pk-yrs or >20 pk-yrs (88% vs. 91% vs 89%; pZ0.80). However, active smokers had significantly inferior 3yr FRR rates compared to never/former smokers (74% vs. 91%; pZ0.0006). For patients with limited T-stage and bilateral nodal disease (T1-2N2c), 3-yr FFR rates were excellent in pts with <10pkyrs compared to those with >10pk-yr (100% vs. 82%; pZ0.07). In a subset of pts with the most anatomically advanced disease within the otherwise favorable subgroup (T3N2b), a lower than expected 3-yr FFR was observed (70% vs. 92% in T1-2N1-2b/T3N0-2a pts; pZ0.008), which was independent of pk-yrs (pZ0.68). Conclusion: Pts with anatomically favorable (T1-2N1-2b or T3N0-2a) HPV+ OPC, who are not active smokers have low rates of recurrence independent of pk-yrs. Similarly, patients with limited T-stage and bilateral nodal disease (T1-2N2c), but with <10 pk-yrs of smoking have low recurrence rates with standard of care therapy. Neither of these pt groups are likely to benefit from treatment intensification trials. Conversely, pts with T3N2b disease have higher than expected failure rates independent of smoking exposure and are poor candidates for deintensification studies. Author Disclosure: S. Koyfman: None. R.B. Ross: None. N.P. Joshi: None. N. Houston: None. C.A. Reddy: None. J.F. Greskovich: None. N.M. Woody: None. J.L. Geiger: None. E. Lamarre: None. B. Prendes: None. R.R. Lorenz: None. J. Scharpf: None. B.B. Burkey: None. D.J. Adelstein: None. M.C. Ward: None.