ESTRO 38 Abstract book

S663 ESTRO 38

Purpose or Objective The management of elderly patients with head and neck cancer (HNC) still remains a challenge with no clear guidelines. Selection criteria for treatment decision are yet elaborative and based on specific factors impacting the patient’s performance status. The aim of this retrospective study is to derive recommendations for daily practice and to develop the optimized individual treatment concept for elderly patients ≥70 years. Material and Methods 146 patients with HNC treated by any kind of radiotherapy (RT) aged ≥ 70 years at diagnosis (median age 77.9 years, SD +6.37) at the Dept. of RadioOncology and Radiotherapy at the Technical University Munich between February 2009 and December 2016 were analyzed. The data collection is based on patient’s medical records, tumor registry and the department’s internal database. Kaplan-Meier Analysis, log rank test and univariate analysis were utilized to compare the outcome survival (OS) stratified by age, treatment, treatment intention, TNM staging and comorbidity impacts via Age-adjusted Charlson Comorbidity Index (ACCI) differentiated in groups: Low (3- 5): n = 89 (61.0%); medium (6-8) n= 41 (28.1%); high (9-11) n=16 (11.0%). Results Patients with all radiotherapy approaches (definitive, adjuvant or palliative) were included in this analysis. The median OS of all patients was 41.7 mo. (95%CI: 34.2-49.2 mo.).The single dose of RT varied between 1.7-2.7 Gy and the total doses between 4-70.4 Gy depending on the treatment concept. There are significant differences of OS in all categories: Age category (70-79 yrs.: 50.0 months (95%CI: 40.7-59.4mo) vs. 80-89 yrs.: 25.0 months (95%CI: 16.6-33.3mo) vs. ≥ 90 yrs.:13.0 months (95%CI: 1.2- 24.8mo) and ACCI Groups (Low ACCI: 50.1 mo. (95%CI: 40.6 - 59.7 mo.) with a mortality of 34 (37.4%) pts. vs. Medium ACCI: 20.9 mo. (95%CI: 10.0 -29.8 mo.) with a mortality of 25 (61.0%) pts. vs. High ACCI: 24.8 mo. (95%CI: 9.8 – 39.7 mo.) with a mortality of 10 (62.5%) pts.), and treatment (RT alone med. OS 31.9 mo. (95%CI: 24.7-39.0 mo.) vs. CRT med. OS 73.9 mo. (95%CI: 60.4- 87.4 mo.). Most benefit for younger patients with the best survival prognosis after CRT and a lower ACCI. Therapy- induced complications were detected such as radiomucositis n = 72 (49.3%), radiodermatitis n = 60 (41.1%), dysphagia n = 50 (34.2%), nausea n= 20 (13.7%), PEG complication n=18 (12.3%), additional chemotherapy induced anemia n = 10 (6.8%), mouth dryness n =8 (5.5%). Required supportive placements included PEG tube n= 52 (35.6%), tracheostomy n= 32 (21.9%), port catheterizations n = 24 (16.4%). Conclusion Analyzing ACCI groups within the CRT collective was to assess a possible influence on OS. The evaluation is skewed due to a small number of patients with a high ACCI Score who underwent CRT. The impact of therapy-induced complications on the outcome survival and therapeutical process needs to be put into consideration. The assessment of required supportive placements can be a useful predictor to measure the severity of adverse events. EP-1197 Pattern, timing, and detection of recurrence in HPV positive oropharyngeal cancer M. Echevarria 1 , L. Harrison 1 , A. Trotti 1 , J. Caudell 1 1 H. Lee Moffitt Cancer Center and Research Institute, Radiation Oncology, Tampa, USA Purpose or Objective HPV positive oropharyngeal cancer has a new staging system, reflecting their higher cure rates. Given high cure rates, the most efficient surveillance scheme and optimal post treatment monitoring tools for this patient population have not been established. We therefore sought to evaluate the pattern, timing, and detection of

Aarhus, Denmark ; 4 Aarhus University Hospital, Unit for Psychooncology and Health Psychology- Department of Psychology and Behavioural Sciences, Aarhus, Denmark ; 5 Aarhus University Hospital, Department of Oncology- Danish Center for Particle Therapy, Aarhus, Denmark Purpose or Objective Proton therapy (PT) may be beneficial in the treatment of sinonasal carcinomas (SNC) as normal tissue may be spared and radiation-induced sequelae, thus, reduced. Evaluation of late toxicity is important for patient selection and evaluation of PT. Therefore, we aimed to objectively assess late toxicity and quality of life (QoL) in patients treated with intensity modulated radiotherapy (IMRT) for SNC. Material and Methods All patients who were alive, without recurrence, and who had received IMRT for SNC between January 2008 - January 2017 were eligible for this cross sectional study. Out of 26 eligible patients, 18 consented to participate. All participants had been treated with primary or postoperative IMRT with or without concomitant chemotherapy. Late toxicities were evaluated with a battery of standardized neurocognitive tests assessing different cognitive domains, comprehensive objective ophthalmological examination, blood samples and synachten test evaluating pituitary function, and olfactory assessment with the Brief Smell Identification Test (BSIT). QoL was evaluated with EORTC QLQ-C30, EORTC QLQ- BN20, Sinonasal Outcome Test-22 (SNOT-22) and Hospital Anxiety and Depression Scale (HADS). In addition, diffusion-weighted magnetic resonance imaging of the brain was performed. These results are not included here. Results Thirteen males and five females were enrolled; median age was 70.5 years (range 47-83). Participants were treated with a prescribed dose of 60-68 Gray to T-sites in the nasal cavity (n=11) or the maxillary sinus (n=7). Compared with normative data, patients evidenced poorer neurocognitive functioning in several cognitive domains including processing speed ( p <0.05), verbal learning and memory ( p <0.01), attention and working memory ( p <0.05), and verbal fluency ( p <0.01). Assessment of vision revealed a significant correlation between max radiation dose to the chiasm and grade 3 visual acuity impairment ( p =0.046) (CTCAE ver. 4.0). The function of the pituitary gland did not present any significant dose response correlations; however, there was an indication of a relationship between higher doses and more affected hormone levels in all axes. Olfactory functioning was impaired (BSIT ≤ 8 points) in 15/18 patients. In the global QoL analyses, the most affected domains were social-, emotional-, and physical functions, whereas drowsiness and fatigue were the highest scoring symptoms. No abnormal depression scores were found, but 15/18 participants reported increased anxiety. Anxiety was related to a poorer outcome in the global QoL score ( p =0.029). SNOT-22 evaluated the impact of sinonasal symptoms on the QoL. The areas that affected the QoL most were lack of smell or taste, thick nasal discharge, need to blow the nose, and blocked nose. Conclusion The results of the present study indicate considerable toxicity subsequent to IMRT with a substantial influence on patient QoL. Due to these initial findings, the study group intent to perform a larger nationwide study. EP-1196 Treatment of elderly head and neck cancer patients: Update on comorbidity impacts and complications H. HA 1 , S.E. Combs 1 , S.U. Pigorsch 1 1 Klinkum rechts der Isar- TUM Munich, Dept. of RadioOncology and Radiation Therapy, Munich, Germany