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Trismus Management after Radiation Therapy in Head and Neck Cancer: A French National Survey of Practice
Poster Viewing Session E333
Volume 93 Number 3S Supplement 2015 (RT) are evaluated and closely followed by a registered oncologic dietitian. In this report, we analyze nutritional factors and compliance with dietary recommendations for associations with overall survival (OS) and progression-free survival (PFS) in patients receiving definitive RT for laryngeal and oropharyngeal cancers. Materials/Methods: We identified 352 patients with non-metastatic oropharyngeal (146) and laryngeal (206) cancer who were treated with definitive RT between 2004 and 2013. Disease and patient characteristics, treatment information, compliance with nutritional program, and clinical outcomes data were tabulated. Adherence to the nutritional program was scored weekly and patients were deemed non-compliant with nutritional program if they cancelled >25% of their appointments with the dietitian, refused nutritional counseling or did not follow recommendations. Of the 352 patients, 158 patients had a pretreatment CT including the abdomen within 30 days of RT start date to assess sarcopenia. Sarcopenia was defined based on muscle areas at the level of L3 using cutoffs established by Prado et al. Descriptive statistics, Kaplan Meier survival analysis, and log rank tests were performed, and Cox regression models were used to examine predictors of OS and PFS. Results: The median follow-up for the entire cohort was 22.86 (0.56-116) months. The actuarial rates for OS were 91%, 86% and 73% at years 1, 2, and 5, respectively. 70.9% (112/158) of patient with abdominal CT prior to starting RT were sarcopenic with a median muscle mass index of 48.2 (range: 30.4-70.9) for males and 35.9 (range: 24.6-53.2) for females. 85.8% (302/352) of patients met with a dietitian during their course of RT and 62.5% of patients who met with dietitian were compliant with the nutritional program. Compliance with the nutritional program resulted in 27% (HR: 0.73, 95% CI: 0.43, 1.26) and 31% (HR: 0.69, 95% CI: 0.50, 0.94) protection from death and disease progression. Lower pretreatment BMI was associated with a higher risk for death (HR: 0.94, 95%CI: 0.90, 0.99) and disease progression (HR: 0.96, 95% CI: 0.93, 0.99). Sarcopenia was not independently predictive for increased risk for overall death and disease progression. Conclusion: Laryngeal and oropharyngeal cancer patients treated with definitive RT who are compliant with an aggressive nutritional program appear to have improved outcomes. Sarcopenia is very common in this patient population and further studies exploring ways to increase compliance with nutritional programs are warranted. Author Disclosure: R. Kabarriti: None. N. Ohri: None. A. Bontempo: None. M. Romano: None. C. Modi: None. S. Viswanathan: None. D. Mark: None. K.P. McGovern: None. A. Ramirez: None. H. Haynes: None. S. Patel: None. T.J. Ow: None. A. Tassler: None. S. Packer: None. B.A. Schiff: None. R.V. Smith: None. M. Haigentz: None. C. Guha: None. S. Kalnicki: None. M.K. Garg: None.
2828 Trismus Management after Radiation Therapy in Head and Neck Cancer: A French National Survey of Practice A. Leysalle,1 K. Benezery,2 M.E. Chand,3 A. Bozec,4 G. Poissonnet,5 O. Dassonville,1 A. Falk,6 J.M. hannoun-Levi,7 M. Serris,1 and F. Mesnard1; 1Lacassagne cancer center, Nice, France, 2Centre Antoine Lacassagne, Nice, France, 3Lacassagne Cancer center, Nice, France, 4lacassagne cancer center, Nice, France, 5Lacassagne Cancer center, Nice, France, 6Centre Antoine-Lacassagne, Nice, France, 7 University of Nice Sophia, Nice, France Purpose/Objective(s): The prevalence of trismus (T) after radiation therapy in head and neck cancer (HNC) ranges from 5% to 38%. There is no standardized T management for head and neck cancer patients and evidence to support any particular protocol. To gain an understanding of current usual practices, a national internet-based survey was developed and sent to all therapists treating HNC patients, as speech therapists (SLPs), physiotherapist (Pi), dentist, and osteopath (Os). Materials/Methods: Questions were generated after discussion and the agreement of all members of a HN multidisciplinary team and were
hosted on a website. Therapists were contacted with an e-mail invitation containing a link to the hosting website. The internet-based questionnaire of 66 questions was administered from May 22 to December 9 2014. Results: A total of 370 participants responded to the internet based survey, the distributions of professions of the responders were as follow: SLPs 284, Pi 50, dentist 1, and Os 35. During their initial training 12% of the interviewed therapists had education on T, 88.37% of them judged the teaching incomplete or insufficient. For 100% of Pi and Os, and 85% of SLPs considered T as part of their domain of skills. Pi considered themselves as highly qualified in 36.39% of case, Os 33.42%, SLP 32.08%. Among the professionals that support specific HN pathologies 17% Os, 32% SLPs, 26% Pi have already treated T, while 21% of Pi, 29% of SLP and 25% of Os have never treated T. For 82% of this population lack of training is the major reason. Among the professionals who do not treat specific HN pathologies the major reasons cited are “never faced this type of pathology” (79%), “not trained” (27%), “not interested” (13%). For therapists 61% of the patients had difficulty to find a professional able to treat them. Usual practices were analyzed, the results suggested that therapists intervened reactively (75%) rather than proactively (25%). However therapists are more likely to intervene with patients proactively (63%) than curatively (37%). Therapists believe in 96% of case that the exercises should be performed every day. The intensity proposed is: less than 5 min 44%, between 6 and 10 min 32%, 15 min 14%, more than 20 min 10%. For 61% of patient the therapists judged the compliance satisfactory. All the categories of therapists proposed thermotherapy (25.5%), relaxation (65%), massage (92%), passive motion exercises (82%), active motion exercises (94%), manual stretching (80%), breathing (76%), technical compensatory (82%), and use of a jaw rehabilitation device (33%). Conclusion: Responses from 370 therapists revealed that there is a lack of consensus regarding timing, intensity, and type of T therapy. This is undoubtedly due the lake of training, to a paucity of research addressing the efficacy of T treatments in the HNC population. Author Disclosure: A. Leysalle: None. K. Benezery: None. m. Chand: None. A. Bozec: None. G. Poissonnet: None. O. Dassonville: None. A. Falk: None. J. Hannoun-Levi: None. M. Serris: None. F. Mesnard: None.
2829 Intensity Modulated Radiation Therapy With Cetuximab Versus Platinum Chemotherapy in p16-Positive Oropharyngeal Squamous Cell Carcinoma N. Nolan,1 V.M. Diavolitsis,1 D. Blakaj,1 X. Pan,1 J.C. Grecula,2 P. Savvides,1 and A.D. Bhatt1; 1Ohio State University Wexner Medical Center, Columbus, OH, 2The Ohio State University Wexner Medical Center, Columbus, OH Purpose/Objective(s): Comparison between radiation with concurrent platinum-based chemotherapy and cetuximab for patients with p16 positive oropharyngeal squamous cell carcinoma (OPSCC) is currently under evaluation. Cetuximab is commonly felt to be favorable to platinum in its toxicity profile, and thus represents a step towards de-escalating morbidity in this population with improved survival outcomes. Our study compared outcomes of p16-positive OPSCC patients treated with intensity modulated radiation therapy (IMRT) + cetuximab to IMRT + platinum-based chemotherapy. Materials/Methods: We conducted an IRB-approved retrospective review of all locally advanced OPSCC patients treated between 2010 and 2013. Of these, 168 were noted to be p16 positive and were the subject of this study. Both postoperative patients treated to at least 6600cGy (NZ23) and definitively (6996-7020cGy, NZ145) treated patients were included. All patients received concurrent chemotherapy, weekly cetuximab (NZ42) or platinum based (NZ126, Cisplatin-109, Carboplatin-17). Statistics utilizing Kaplan-Meier and Cox Regression model were conducted for univariate and multivariate analyses (MVA).
Volume 93 Number 3S Supplement 2015 (RT) are evaluated and closely followed by a registered oncologic dietitian. In this report, we analyze nutritional factors and compliance with dietary recommendations for associations with overall survival (OS) and progression-free survival (PFS) in patients receiving definitive RT for laryngeal and oropharyngeal cancers. Materials/Methods: We identified 352 patients with non-metastatic oropharyngeal (146) and laryngeal (206) cancer who were treated with definitive RT between 2004 and 2013. Disease and patient characteristics, treatment information, compliance with nutritional program, and clinical outcomes data were tabulated. Adherence to the nutritional program was scored weekly and patients were deemed non-compliant with nutritional program if they cancelled >25% of their appointments with the dietitian, refused nutritional counseling or did not follow recommendations. Of the 352 patients, 158 patients had a pretreatment CT including the abdomen within 30 days of RT start date to assess sarcopenia. Sarcopenia was defined based on muscle areas at the level of L3 using cutoffs established by Prado et al. Descriptive statistics, Kaplan Meier survival analysis, and log rank tests were performed, and Cox regression models were used to examine predictors of OS and PFS. Results: The median follow-up for the entire cohort was 22.86 (0.56-116) months. The actuarial rates for OS were 91%, 86% and 73% at years 1, 2, and 5, respectively. 70.9% (112/158) of patient with abdominal CT prior to starting RT were sarcopenic with a median muscle mass index of 48.2 (range: 30.4-70.9) for males and 35.9 (range: 24.6-53.2) for females. 85.8% (302/352) of patients met with a dietitian during their course of RT and 62.5% of patients who met with dietitian were compliant with the nutritional program. Compliance with the nutritional program resulted in 27% (HR: 0.73, 95% CI: 0.43, 1.26) and 31% (HR: 0.69, 95% CI: 0.50, 0.94) protection from death and disease progression. Lower pretreatment BMI was associated with a higher risk for death (HR: 0.94, 95%CI: 0.90, 0.99) and disease progression (HR: 0.96, 95% CI: 0.93, 0.99). Sarcopenia was not independently predictive for increased risk for overall death and disease progression. Conclusion: Laryngeal and oropharyngeal cancer patients treated with definitive RT who are compliant with an aggressive nutritional program appear to have improved outcomes. Sarcopenia is very common in this patient population and further studies exploring ways to increase compliance with nutritional programs are warranted. Author Disclosure: R. Kabarriti: None. N. Ohri: None. A. Bontempo: None. M. Romano: None. C. Modi: None. S. Viswanathan: None. D. Mark: None. K.P. McGovern: None. A. Ramirez: None. H. Haynes: None. S. Patel: None. T.J. Ow: None. A. Tassler: None. S. Packer: None. B.A. Schiff: None. R.V. Smith: None. M. Haigentz: None. C. Guha: None. S. Kalnicki: None. M.K. Garg: None.
2828 Trismus Management after Radiation Therapy in Head and Neck Cancer: A French National Survey of Practice A. Leysalle,1 K. Benezery,2 M.E. Chand,3 A. Bozec,4 G. Poissonnet,5 O. Dassonville,1 A. Falk,6 J.M. hannoun-Levi,7 M. Serris,1 and F. Mesnard1; 1Lacassagne cancer center, Nice, France, 2Centre Antoine Lacassagne, Nice, France, 3Lacassagne Cancer center, Nice, France, 4lacassagne cancer center, Nice, France, 5Lacassagne Cancer center, Nice, France, 6Centre Antoine-Lacassagne, Nice, France, 7 University of Nice Sophia, Nice, France Purpose/Objective(s): The prevalence of trismus (T) after radiation therapy in head and neck cancer (HNC) ranges from 5% to 38%. There is no standardized T management for head and neck cancer patients and evidence to support any particular protocol. To gain an understanding of current usual practices, a national internet-based survey was developed and sent to all therapists treating HNC patients, as speech therapists (SLPs), physiotherapist (Pi), dentist, and osteopath (Os). Materials/Methods: Questions were generated after discussion and the agreement of all members of a HN multidisciplinary team and were
hosted on a website. Therapists were contacted with an e-mail invitation containing a link to the hosting website. The internet-based questionnaire of 66 questions was administered from May 22 to December 9 2014. Results: A total of 370 participants responded to the internet based survey, the distributions of professions of the responders were as follow: SLPs 284, Pi 50, dentist 1, and Os 35. During their initial training 12% of the interviewed therapists had education on T, 88.37% of them judged the teaching incomplete or insufficient. For 100% of Pi and Os, and 85% of SLPs considered T as part of their domain of skills. Pi considered themselves as highly qualified in 36.39% of case, Os 33.42%, SLP 32.08%. Among the professionals that support specific HN pathologies 17% Os, 32% SLPs, 26% Pi have already treated T, while 21% of Pi, 29% of SLP and 25% of Os have never treated T. For 82% of this population lack of training is the major reason. Among the professionals who do not treat specific HN pathologies the major reasons cited are “never faced this type of pathology” (79%), “not trained” (27%), “not interested” (13%). For therapists 61% of the patients had difficulty to find a professional able to treat them. Usual practices were analyzed, the results suggested that therapists intervened reactively (75%) rather than proactively (25%). However therapists are more likely to intervene with patients proactively (63%) than curatively (37%). Therapists believe in 96% of case that the exercises should be performed every day. The intensity proposed is: less than 5 min 44%, between 6 and 10 min 32%, 15 min 14%, more than 20 min 10%. For 61% of patient the therapists judged the compliance satisfactory. All the categories of therapists proposed thermotherapy (25.5%), relaxation (65%), massage (92%), passive motion exercises (82%), active motion exercises (94%), manual stretching (80%), breathing (76%), technical compensatory (82%), and use of a jaw rehabilitation device (33%). Conclusion: Responses from 370 therapists revealed that there is a lack of consensus regarding timing, intensity, and type of T therapy. This is undoubtedly due the lake of training, to a paucity of research addressing the efficacy of T treatments in the HNC population. Author Disclosure: A. Leysalle: None. K. Benezery: None. m. Chand: None. A. Bozec: None. G. Poissonnet: None. O. Dassonville: None. A. Falk: None. J. Hannoun-Levi: None. M. Serris: None. F. Mesnard: None.
2829 Intensity Modulated Radiation Therapy With Cetuximab Versus Platinum Chemotherapy in p16-Positive Oropharyngeal Squamous Cell Carcinoma N. Nolan,1 V.M. Diavolitsis,1 D. Blakaj,1 X. Pan,1 J.C. Grecula,2 P. Savvides,1 and A.D. Bhatt1; 1Ohio State University Wexner Medical Center, Columbus, OH, 2The Ohio State University Wexner Medical Center, Columbus, OH Purpose/Objective(s): Comparison between radiation with concurrent platinum-based chemotherapy and cetuximab for patients with p16 positive oropharyngeal squamous cell carcinoma (OPSCC) is currently under evaluation. Cetuximab is commonly felt to be favorable to platinum in its toxicity profile, and thus represents a step towards de-escalating morbidity in this population with improved survival outcomes. Our study compared outcomes of p16-positive OPSCC patients treated with intensity modulated radiation therapy (IMRT) + cetuximab to IMRT + platinum-based chemotherapy. Materials/Methods: We conducted an IRB-approved retrospective review of all locally advanced OPSCC patients treated between 2010 and 2013. Of these, 168 were noted to be p16 positive and were the subject of this study. Both postoperative patients treated to at least 6600cGy (NZ23) and definitively (6996-7020cGy, NZ145) treated patients were included. All patients received concurrent chemotherapy, weekly cetuximab (NZ42) or platinum based (NZ126, Cisplatin-109, Carboplatin-17). Statistics utilizing Kaplan-Meier and Cox Regression model were conducted for univariate and multivariate analyses (MVA).