Abstract Book

ESTRO 37

S356

Hemato-Oncology, Milan, Italy 3 European Institute of Oncology, Dietetic and Clinical Nutrition Unit, Milan, Italy 4 European Institute of Oncology, Medical Oncology Division of Urogenital and Head and Neck Tumors, Milan, Italy 5 European Institute of Oncology, Department of Head and Neck Surgery, Milan, Italy Purpose or Objective Although nutritional status is steadily emerging as a predictive and prognostic parameter in head and neck cancer (HNC) radiation therapy (RT), the nutritional protocols in use are not based on a high evidence-based consensus. To address this unmet need, the aim of the current study was to test the applicability and clinical outcomes of a stepped-wedge nutritional protocol on a series of HNC patients (pts) treated at a tertiary care center. Material and Methods Prospective administration of a multidimensional nutri- tional protocol with stepped-wedge design; Inclusion criteria were as follows: 1) histologically-proven HNC, 2) no previous radical surgery (excisional biopsy and /or ipsilateral neck dissection were allowed), 3) indication to curative-intent RT, 4) weight loss (WL)<10% in the 3 months prior to the RT start date, 5) absence of swallowing disorders at the baseline. WL was assessed both as a continuous and a categorical variable and graded per Common Terminology Criteria for Adverse Events (CTCAE v4.03). Nutritional status was measured by an expert dietitian at the baseline and at every following week during the whole course of RT. Fluid intake and caloric intake were estimated through a 24-hour recall. Estimated caloric requirement was determined by the Harris Benedict equation. Patient reported outcomes were assessed through a reduced version of the validated Patient-Generated Subjective Global Assessment scale. Nutritional supplementation (NS) was administered according to best clinical practice and patients' preference. The protocol work flow is depicted in Fig 1 .

Volume (PTV), OAR volume and OAR radiotherapy dose were analysed. Results Between 02/01/2013 and 30/06/2016, We had 1053 H&N cancer case discussed at MDT, 484 patients had been treated with Intensity-modulated radiation therapy (IMRT). Radiological Inserted Gastrostomy (RIG) was 27.1 % (285/1053) of all patients. Unfortunately 43 patients died with enteral feeding tube in-situ and 19 patients had TFD. TFD rate was 1.87% of all patients. 6 of the patients with TFD had tumour recurrence and 14 had no residual disease after definitive treatment. Radiotherapy induced TFD was limited to 2.4 %( 12/484) of all IMRT treatments which although is a small fraction of patients it had significant and long term sequelae to the patients. Radiotherapy induced TFD tumour sites were common in Oropharynx as 7 oropharynx, 3 laryngeal and 3 oral cavity carcinomas. There was fairly equal distribution of T but majority had node positive disease. Mean PC OAR volume were 309.2cc and with a mean dose to PTV 63.6, Gy, Mean dose to Superior PC muscle was 59.4, Mean dose to M+L PC muscle 52.8Gy, Mean dose to Superior pharyngeal constrictor muscle (S+M+L ) 57.3Gy. Correlation coefficient of the Dose and Volume of organ at risk showed r=0.23.

Conclusion A weak correlation was noted between the volumes and radiotherapy doses of PC muscle included in radiation field. TFD as classified as severe late radiotherapy toxicity occur in 2.4 %, yet has long term implication for patients quality of life and financial implication on health care services. PO-0699 Weight loss in head and neck cancer: proof of concept for a stepped-wedge nutritional protocol S. Volpe 1,2 , G. Marvaso 1 , D. Alterio 1 , A. Sabbatini 3 , E. Zagallo 3 , F. Valoriani 3 , G. Fanetti 1,2 , A. Ferrari 1 , M. Cossu Rocca 4 , M. Ansarin 5 , B.A. Jereczek Fossa 1,2 1 European Institute of Oncology, Department of Radiation Oncology, Milan, Italy 2 University of Milan, Department of Oncology and

Results Forty-two consecutive predominantly male HNC patients were treated within the nutritional protocol at our institution between May 2010 and March 2011. Median age was 63 years (range 34-76 years); mean total RT dose was 69.7 Gy. Nine (21%) pts underwent induction chemotherapy; 36 (86%) pts received concurrent systemic treatment, which was platinum-based chemotherapy in 25 cases (69%) and Cetuximab in 11 (31%). WL according to CTCAE 4.03 was G0 in 23 (55%) pts, G1 in 14 (33%), G2 in 5 (12%). All pts received oral NS during RT. Thirty-five (83%) pts did not require enteral nutrition. Among the 7 pts who received indication to enteral nutrition, 3 refused the insertion of a nasogastric tube. Therefore, 90% of pts could complete RT without interrupting oral feeding.