ESTRO 2021 Abstract Book

S797

ESTRO 2021

Funded by the German Research Council (ZI736/2-1, PAK 997/1)

PO-0956 Radiotherapy in fragile elderly head and neck cancer patients: a single centre experience I. Luciani 1 , C. Pisani 2 , L. Masini 2 , V. Destefanis 2 , S. Berretta 3 , E. Ferrara 2 , G. Loi 4 , M. Krengli 2 1 University Hospital "Maggiore della Carità", Division of Radiation Oncology,, Novara, Italy; 2 University Hospital "Maggiore della Carità", Division of Radiation Oncology, Novara, Italy; 3 University Hospital "Maggiore della Carità",, Division of Radiation Oncology, Novara, Italy; 4 University Hospital "Maggiore della Carità", Medical Physics, Novara, Italy Purpose or Objective Elderly patients with head and neck cancer presenting with multiple comorbidities - diabetes, cardiac diseases, renal insufficiency, poor nutritional status, immobility, and cognitive decline - represent a challenging clinical dilemma. The purpose of the study was to assess and analyze factors which could influence toxicity, compliance and treatment response. Materials and Methods We selected head and neck cancer patients aged ≥75 years, treated with 3D-CRT (three-dimensional conformal radiotherapy), IMRT (Intensity-modulated radiation therapy) or VMAT (Volumetric modulated arc therapy) from 2004 to 2019. Patients were screened with Geriatric-8 tool (G8) test. Results We included 80 patients, 61 males and 19 females, with a mean age of 80 (range: 76-83.5) at diagnosis. 8 had diabetes (10%) and 29 had hypertension (36.3%). 12 had stage I disease (15%), 18 stage II (22.5%), 26 stage III (32.5%) and 24 stage IV (30%). All patients were defined as frail according to G8 score. Radiotherapy with curative intent was performed in 86.3% of the cases with a mean prescription dose of 66 Gy (range: 60-70) and a mean BED (Biologically Effective Dose) of 79.2 (range: 70-84). 11 patients were treated in palliative setting. Ten patients required preventive PEG (percutaneous endoscopic gastrostomy) to ensure adequate nutrition during treatment. According to RTOG acute toxicity scale, G2 mucositis was the most frequent (43.8%), followed by G1 (42.5%) and G3 (13.7%). We observed a statistically significantly correlation between mucositis and hypertension (p-value 0.0122) and CTV (p-value 0.0005). Patients developed mainly G1 skin toxicity (42.50%), followed by G2 (38.75%) and G3 (18.75%). The only variable related to acute skin toxicity was sex (p- value 0.0089), with a worse outcome for male. In curative setting, we found 47.5% of CR (complete response), 22.5% of PD (progression disease), 5% of PR (partial response); 20 patients (25%) were lost to follow-up. Only eight patients faced a temporary treatment interruption (median: 4 days, SD: 3-5). The median follow-up was 300 days (range: 92.25-809.25) with a cumulative incidence function CR/PR of 28% within 12 months and of 50% within 27 months. Conclusion From our analysis, radiotherapy can be an appropriate treatment option in elderly patients. As already demonstrated, the chronological age could not be taken into consideration as the only factor capable of excluding an elderly patient from definitive treatment. Our results are promising in terms of efficacy and tolerance, with a good toxicity profile. We also demonstrated that exclusive radiotherapy, when used with curative intent, treatment enabled a durable response over time. PO-0957 Organ-preservation in Post-Cricoid and Upper-Esophagus (PCUE) cancers: Seeking optimum outcomes S. Sinha 1 , S. Ghosh Laskar 1 , M. Singh 1 , A. Budrukkar 1 , N. Mummudi 1 , M. Swain 1 , J.P. Agarwal 1 , T. Gupta 1 , V. Murthy 1 , K. Prabhash 2 , A. Joshi 2 , V. Noronha 2 , V. Patil 2 , N. Menon 2 1 Tata Memorial Centre, Homi Bhabha National Institute, Radiation Oncology, Mumbai, India; 2 Tata Memorial Centre, Homi Bhabha National Institute, Medical Oncology, Mumbai, India Purpose or Objective There is a paucity of prospective data and lack of consensus in the management of post-cricoid and upper- esophagus (PCUE) cancers owing to their relative rarity in the West. This study prospectively examines the toxicity, prognostic factors and outcomes of patients with PCUE cancers treated with an organ-preservation approach of (chemo)-radiotherapy (CTRT) using intensity-modulated image-guided radiotherapy (IM-IGRT). Materials and Methods This was a phase II prospective observational study performed at a tertiary cancer care centre. Forty patients with biopsy-proven PCUE squamous cell cancers with stage T1-3,N0-2,M0 planned for definitive CTRT were accrued from February 2017 to January 2020. Gross exolaryngeal extension or a dysfunctional larynx were major criteria for exclusion. Baseline and staging work-up comprised UGIE, FDG PETCT and FESS by a speech- language therapist (SLT). Patients received 66Gy in 30 once-daily fractions using volumetric modulated arc treatment (RapidArc TM , Varian Medical Systems, Palo Alto) and daily kV-CBCT verification. Response was assessed at 10-12 weeks following CTRT and patients were reviewed by SLT at every follow-up. Outcome measures included OS, EFS, CSS and LRC, along with RTOG toxicities, long-term feeding-tube (FT) dependency and patterns of failure. Results Median follow-up at the time of analysis was 22 months (IQR, 16-25 months). The cohort had a median age of 51 years with female preponderance (2:1). Twenty-six (87.5%) patients at presentation had loco-regionally advanced disease. Disease involving both post-cricoid and upper esophagus was seen in 24 (60%) patients. Thirty-four patients (85%) received CTRT, most common concurrent regimen being 40 mg/m 2 weekly IV cisplatin. The most common acute toxicity was grade 2 dermatitis (25; 62.5%) followed by grade 2-3 odynophagia (22; 55%). FT requirement at presentation was seen in 11 (27.5%) patients, while, long-term FT dependency at 6 months was seen in 10 (37%) patients. Complete response was seen in 26 (65%) patients and 18 (45%) patients were alive and disease-free at the time of analysis. The 2-year OS, EFS, CSS and LRC were 44.8%, 40.2%, 53% and 59.6%, respectively. Volume of primary tumor (GTV-Pvol) more than 28cc had a