Abstract book - ESTRO meets Asia

S58 ESTRO meets Asia 2018

PO-148 Benefits of Elective Tracheostomy in head and neck cancer patients with laryngeal obstruction K.K. Br 1 1 Vydehi Instituite of Medical Sciences,Radiation Oncology , Epip area- white field- Bangalore, India Purpose or Objective Head and neck cancers are among the 10 most common cancers globallyand are the most common cancers in developing countries, especially in Southeast Asia. In India, it accounts for one fourth of male cancers and one tenth of female cancers. Airway obstruction is one of the major morbidities caused by these tumours. Prompt relief of the obstruction would not just save lives but also makes delivery of definitive treatment more effective. The severity of symptoms depends upon the site of obstruction, degree of obstruction and also other physiological factors. Here, we attempted to analyse the correlation between the degree of obstruction at the level of larynx with outcome of the patients in terms of tracheostomy rates and completion of definitive treatment without tracheostomy. Material and Methods All patients diagnosed to have primary cancers of head and neck (includes oropharynx, hypopharynx and larynx) who were treated with radiotherapy between the year January 2009– June2017 were included in the study. Area of the narrowest airway was measured on simulation CT. All the patients who had radiologically significant airway narrowing were analysed in terms of tracheostomy rates. Results Out of 377 head and neck cancer patients which were treated, radiologically significant narrowing of laryngeal airway was observed in 179 patients. 53 patients of them required tracheostomy. Laryngeal airway narrowing could be classified into low, intermediate, high and highest risk for tracheostomy with corresponding tracheostomy rates of 5.8%, 23.5%, 41.6% and 80% respectively. Conclusion All highest risk patients will require prophylactic tracheostomy where as high-risk patients may benefit from tracheostomy. Intermediate risk patients can be considered depending upon other factors like age and co- morbidities. PO-149 Mucolytic N-Acetylcysteine vs Placebo Rinses for Mucositis during Head and Neck Chemoradiotherapy J.C. Rwigema 1 , T. Sio 1 , M. Blanchard 2 , P. Novotny 3 , S. Patel 1 , L. Pederson 3 , M. Gamez 1 , G. Seeger 4 , J. Martenson 2 , Y. Grover 5 , R. Foote 2 , R. Miller 6 , M. Halyard 1 1 Mayo Clinic, Radiation Oncology, phoenix, USA 2 Mayo Clinic, Radiation Oncology, Rochester, USA 3 Mayo Clinic, Biomedical Statistics and Informatics, Rochester, USA 4 Altru Cancer Center, Radiation Oncology, Grand Forks, USA 5 Mayo Clinic, Radiation Oncology, Scottsdale, USA 6 Mayo Clinic, Radiation Oncology, Jacksonville, USA Purpose or Objective Combined chemoradiotherapy is associated with significant treatment-related morbidities in patients with head and neck cancer. Xerostomia and thickened salivary secretions are detrimental to the patient’s quality of life. The purpose of this study was to determine, by patient- reported outcome measures, if an N-acetylcysteine rinse was safe and could improve the patient’s experience with less thickened secretions and dry mouth during and after chemoradiotherapy (RT).

III, 70 (26.4%) stage IVA and 42 (15.8%) stage IVB. 53 (20%) patients received RT alone, 126 (47.5%) and 85 (32.0%) had concurrent chemoradiotherapy (CCRT) and induction chemotherapy followed by CCRT respectively. All patients were treated with intensity modulated RT to a dose of 70Gy. 88 (33.2%) of ptMRIs were CR, 133 (50.2%) were ID, and 44 (16.6%) were PR. Of the 133 patients whose first ptMRI was reported as ID, 104 (78.2%) had a second ptMRI. In this group, 77 (57.9%) of the subsequent MRI were determined to be CR, 21 (15.8%) remained ID and 6 (4.5%) were PR (Table 2). Multivariate analysis showed that T1 tumour stage was associated with increased CR rates on first ptMRI (OR 3.12, 95% CI 1.12 - 8.64, p = 0.029). The median time from end of radiotherapy to having the first ptMRI is 93 days (range 32 - 719). ID status is more likely at 75 - 105 days versus 106 - 135 days post RT (OR 2.13, 95% CI 1.16 - 4.12, p = 0.024). 27 (10.1%) patients had LRR. 20 (74.1%) were picked up by MRI, 3 (11.1%) by nasoendoscopy, 2 (7.4%) by PET-CT.

Conclusion MRI is useful for detecting local recurrence or persistent disease after curative intent treatment. Most patients will require more than one ptMRI to arrive at a definitive status. The rate of ID ptMRIs may be reduced by delaying the first scan to after 105 days post RT.